Orthodontic appliances systems methods and tools

ABSTRACT

Improved orthodontic methods and apparatus are described that reduce the level of skill required for successful treatment, reduce the amount of orthodontist&#39;s time required for successful treatment, and have improved retention. Customized individual orthodontic treatment is possible utilizing brackets ( 92420 ), bands, and archwires ( 1200 ) specifically designed for each malocclusion. Computer software is used to organize hundreds of issues and appliance variations in an automated or semi-automated diagnosis and treatment system. Related tools include a bracket holder ( 500 ) having a handle ( 550 ), a pair of gripping members ( 520, 520 ′) and a gripping member position and orientation indicator ( 600 ) and a bracket vertical position indicator ( 700 ).

This application claims the benefit of U.S. provisional applications No.60/350232, 60/350233 and 60/396338, and U.S. non-provisionalapplications 10/187494 and 10/131454, each of which is incorporatedherein by reference in its entirety.

FIELD OF THE INVENTION

The field of the invention is orthodontic appliances, systems, methods,and tools.

BACKGROUND OF THE INVENTION

Dentists, orthodontists in particular, often use orthodontic hardwaresuch as brackets and archwires in the prevention or correction ofirregularities of the teeth, particularly irregularities that result inmalocclusions (faulty contact between the upper and lower teeth when thejaw is closed). Dentists also use orthodontic hardware to treat teethhaving undesirable orientations. Undesirable orientations generallyeither occur naturally or are a result of tooth repositioning duringorthodontic treatment.

An orthodontic bracket is generally a metal or ceramic part fastened toa tooth to serve as a means for fastening an archwire. An archwire is ametal wire that is attached to the brackets to move the teeth of apatient in a manner desired by the patient's dentist. An example of abracket and archwire assembly is shown in FIG. 1 with bracket 10 beingbonded to tooth 40, and archwire 20 being coupled to bracket 10 byligature wire 30. Bracket 10 comprises base 11, and stems 12 and 13.Stems 12 and 13 each comprise two tie wings (12A, 12B, 13A, and 13B) andan archwire receiving slot (12C and 13C).

In FIG. 1, bracket 10 can be characterized as having perpendicular axisA1 and A2, and tooth 40 can be characterized as having a central axisA3, and an occlusal plane P1 as shown. In treating a patient, a dentistwill generally use a standard set of 24-28 brackets and 1 archwireengaged into these brackets to apply the forces needed for toothmovement.

Due to the small size of the brackets, it is generally desirable to usea holder such as a tweezers or pliers to pick up position bracket 10 ona tooth 40. The positioning and alignment of bracket 10 relative totooth 40 is particularly important to a dentist, as it tends to stronglyimpact the movement of tooth 40 during treatment. As such, it isgenerally desirable to position bracket 10 at a particular heightrelative to the top/occlusal surface of the tooth. Referring to FIGS.2A-2C, the position of bracket 10 may be adjusted such that: (a) thevertical distance D1, the distance between the occlusal plane P1 orocclusal surface of tooth 40 and horizontal axis A2, is a desired value;(b) the horizontal distance D2, the horizontal component of the distancebetween axis A1 of bracket 10 and axis A3 of tooth 40, is a desiredvalue (possibly zero); and the angle E1 between axis A1 and axis A3 is adesired value (also possibly zero). Unfortunately, properly positioningand aligning bracket 10 is not always easy to accomplish. Because ofthis, tools for aiding in the holding, positioning, and aligning ofbrackets have been developed. Examples of such tools can be found atleast in U.S. Pat. Nos. 5,868,787 and 4,850,864, in U.S. Pat. No.5,810,582 and in U.S. Pat. Nos. 6,296,482, 5,312,248, and 5,304,061.However, this list is not exhaustive as other types of holders, gauges,and other tools are also known.

One type of holder that is particularly suitable for comparison purposesis the bracket holding tweezer of FIG. 3. In FIG. 3, tweezer 50comprises a pair of elongated members 51 and 51′ placed in an adjacentlengthwise relationship with one another, each member having a first endpart 52 and 52′ and a second end part 53 and 53′, the first end partforming a gripping mechanism 54, and the second end parts coupledtogether to form a handle 55. The tweezers of FIG. 3 is a pre-tensionedor cross-over type having a gripping mechanism 54 comprising a jaw whichis held in the closed position by tension formed by the shape of thetweezers, in particular by the cross-over portion 56 and the couplingtogether of ends 53 and 53′. The user must apply pressure to the members51 and 51′ to open the jaw, align the object upon which the tweezers areto be used with, and then reduce the pressure on the members so that theobject is held by the gripping area In many instances, cross-over typeholders are preferred in the placement of brackets on teeth.

The gripping jaw 54 that includes the first end parts 52 and 52′ of themembers 51 and 51′, includes gripping surfaces 57 and 57′ having frontedges 58 and 58′ that are typically used to grip the tie wings of anorthodontic bracket. The front edges 58 and 58′ of the gripping jaws aretypically inclined relative to a vertical axis to allow the holder to beangled away from the surface of a tooth during placement of a bracket.In some instances their front edges are cutting surfaces.

Archwires generally vary in regard to shape, size, and type of wireused. In previously known methods, initial selection of an archwire istypically accomplished by examination of a patient's teeth to determinewhat size and shape of archwire would be appropriate for that patient.In many instances, the shape to be used is determined by looking at theshape formed by the occlusal surfaces of the teeth, or by looking at theshape formed by the labial and buccal surfaces of the teeth.Unfortunately, determining an appropriate shape by looking at theocclusal or the labial and buccal surfaces of a patient's teeth does notalways result in selection of the optimum archwire shape. Such selectionis generally made more difficult due to variations in tooth shape,position and orientation. Moreover, although taught in school, selectingcustom archwire shapes for each individual patient is generally too timeconsuming for the dentist/orthodontist, reducing the number of patientsthat can be seen in a day, and increasing the fee for those patientsbeing treated.

Undesirable tooth orientations generally either occur naturally or are aresult of tooth repositioning during orthodontic treatment. Undesirableorientations are typically corrected by using one or more of thefollowing methodologies: (a) “bending” arch wires during formation; (b)positioning brackets in a position offset from the center of a toothface; and (c) adjusting adhesive thickness to position a bracket closeor farther from the face of a tooth. Unfortunately, these methodologiesrequire a higher than desired degree of skill to obtain desired effects,and not all orthodontists have the requisite skill. Moreover, wirebending is time consuming and thus adds to the total amount of time anorthodontist must spend treating a particular patient. Use of wirebending methodologies also often leads to poor retention in that teeththat have been orientated correctly tend to move back to an undesiredorientation after treatment is complete. As such, there is an ongoingneed for improved orthodontic methods that reduce the level of skillrequired for successful treatment, reduce the amount of orthodontisttime required for successful treatment, and have improved retention.

SUMMARY OF THE INVENTION

It is contemplated that the prevention or correction of irregularitiesof the teeth of an individual patient (hereinafter “patient treatment”)would be greatly facilitated through the use of the appliances, systems,methods, and tools described herein, and that the invention describedherein may comprise any combination of one or more of the describedappliances, systems, methods, and tools.

In regard to appliances, it is preferred that patient treatment utilizea set of brackets and an archwire customized to a particular patient.Although manufacturing brackets and wires specifically tailored to anindividual would generally be desirable, the cost and time required todo so is contemplated as being economically impractical. An alternativeapproach described herein is to establish a larger set of “standard”brackets and wires so that brackets and wires most suitable for patienttreatment can be selected from the larger set.

Unfortunately, increasing the number of brackets and wires to choosefrom increases the complexity of prescribing and implementing atreatment plan. However, it is contemplated that automating thediagnosis and prescription process as well as the process used forordering orthodontic hardware will make the choice of brackets and wiresmuch more manageable. It is also contemplated that coupling theautomated prescription process to an automated ordering process willdecrease the amount of orthodontic hardware that needs to be stocked bypermitting the ordering of individualized sets of brackets and/or wireson an “as needed” basis.

Such an automated system would make it possible to use an individualpatient's characteristics (such as the malocclusion and facial/musclepatterns), a dentists diagnosis, and the dentists treatment plan to makea personalized bracket and archwire (appliance) system for theindividual patient. The advantage of doing this is to obtain superiortreatment results and reducing treatment time. It is contemplated thatthe system disclosed herein will facilitate “straight wire finishing” soas to decrease or eliminate wire bending. The increase in variety inbrackets results in less wire bending to compensate for the things thebrackets cannot do. Decreasing the amount of required wire bendingreduces treatment time.

To help understand the current invention, various terms and phrases willbe used as names to identify and refer to different aspects of theinvention. As an example, “IP Bracket Set” will be used to refer to aset of brackets, at least one of which is a preferred bracket describedherein, prescribed for a particular patient, and may also include anybands, buccal tubes, or other non-archwire appliance components to beused with in conjunction with the prescribed brackets. “IP Archwire Set”will be used to refer to the one or more archwires, at least one ofwhich is a preferred archwire described herein, prescribed for aparticular patient. “IP Appliance Set” (sometimes “IP Appliance” andsometimes simply “Appliance”) will be used to refer to a combination ofan IP Bracket Set and an IP Archwire Set. “IP Software” will be used torefer one or more of the software tools described herein that facilitatethe prescription, ordering and use of IP Appliance Sets. “IP DiagnosisSoftware” will be used to refer to one or more software tools asdescribed herein adapted to facilitate the prescription of IP ApplianceSets. “IP Ordering Software” will be used to refer to one or moresoftware tools as described herein adapted to facilitate ordering of IPBracket Sets and/or IP Appliance Sets. “IP Band Fitting Kit” will beused to refer to a set of bands kept in stock for the purpose ofallowing a dentist to determine what size and/or type of bands need tobe included in a patient's IP Bracket Set. “IP Bracket Repair Kit” willbe used to refer to a set of brackets kept in stock for the purpose ofquickly repairing or replacing lost or damaged brackets of an IP BracketSet. “GMPOI Holder” will be used to refer to a bracket holder asdescribed herein comprising a gripping member position and orientationindicator. “IP System” will be used to refer to any combination of oneor more of the appliances, systems, methods, and tools described herein.Using these, an embodiment of the invention disclosed herein may becharacterized as the use of the IP System for orthodontic treatment ofpatients, in particular the use of IP Diagnosis Software to specify anIP Appliance Set for a particular patient, using IP Ordering software toorder the specified IP Appliance Set, and using a GMPOI Holder and thespecified IP Appliance Set in treatment of the patient. The process ofspecifying an IP Appliance Set may involve the use of an IP Band FittingKit.

IP Software

The use of computer software for bracket selection and ordering makesthe use of large numbers of brackets and archwires with specificapplications possible in patient treatment at least in part because iteliminates the need for the large and expensive stockpiles of bracketsand archwires that would otherwise be required, and assists in selectionof an appropriate set of brackets and archwires.

GMPOI Holder

The present invention is in part directed to apparatus for holding,positioning, and aligning other apparatus such as orthodontic brackets.Preferred embodiments of such apparatus include one or more of thefollowing: (a) a bracket gripping mechanism; (b) a horizontal positionindicator, (c) a vertical position indicator, and (d) an orientationindicator. In preferred embodiments, various portions of the apparatusserve multiple purposes, and interact with other portions to facilitateuse of the apparatus. A most preferred apparatus comprises a handle, abracket gripping mechanism, a combined orientation and horizontalposition indicator, and a height gauge (vertical position indicator)that can also cooperate with the handle as an orientation indicator.

It is advantageous for a given apparatus to comprise an indicator thatextends vertically upward and/or downward from the apparatus with theindicator providing a visual representation of the location of acenterline of a bracket or other apparatus being positioned. It is alsoadvantageous to have such an indicator be non-perpendicular to a handleportion of the apparatus. If an apparatus comprises jaws, it isadvantageous to position a vertically extending indicator between thejaws such that the indicator is positioned at or near the center of thegap between the jaws when the jaws are being used to hold a bracket orother apparatus. If an apparatus comprises a holder having angled jaws,it is advantageous to have such a vertically extending indicator beparallel to the jaws so as to provide a visual indication of theorientation of the jaws. Any vertically extending indicator is preferredto be near an end of a given apparatus to allow it to be close to abracket or other apparatus being positioned and orientated. However, inthe case of an orthodontic bracket holder, it is preferred that suchvertically extending indicator be set at least slightly back from an endof the holder so as to avoid contact with the teeth and gums of apatient during use.

It is advantageous to be able to use most of the length of an elongatedapparatus to provide a visual indication of the orientation of a bracketor other apparatus being positioned as the longer the indicator meansis, the easier it is to determine improper orientation of the apparatusbeing positioned.

It is advantageous to include both position and orientation indicatorson a holder apparatus so as to allow a bracket or other apparatus to bepositioned and aligned without having to utilize a separate tool. It iscontemplated that one advantage of using such an apparatus is that,particularly when dealing with using a fast setting bonding material tobond a bracket to a tooth, proper position and orientation can beobtained earlier during the setting process with a resultant reductionin risk of damage to the bond that that can be caused by movement duringlater stages of the setting process.

A desirable apparatus can be obtained by modifying an existing bracketholder by adding a height gauge to the handle of a standard bracketholder, and mounting a vertical bar near the jaws of the holder. In sucha configuration, the vertical bar can be used simultaneously as both aposition and orientation indicator. The height gauge can be used firstas a height gauge, and subsequently as an orientation indicator incooperation with a handle of the holder.

It is preferred that an included height gauge have a bracket contactportion set at a fixed distance from a tooth contacting portion will beadvantageous. It is also preferred that the bracket contact portion beadapted to fit within the archwire receiving slots of the stems of abracket, and, preferably, to comprise a wire loop or other mechanismthat permits the bracket holder to be positioned horizontally whilebeing received by the archwire receiving slots even if such slots aretilted upward or downward.

When a height gauge is part of a bracket holder, rotating the heightgauge ninety degrees relative to the jaws of the holder will in manyinstances, position the holder relative to the gauge so as to bestcooperate with the gauge to act as an orientation indicator.

If a bracket holder apparatus comprises multiple planar members adaptedto be partially inserted into a bracket or other apparatus, it ispreferred that the members be co-planar and positioned relative to theremainder of the apparatus so as to best use the remainder of theapparatus of the orientation of the planar members.

It is contemplated that it is advantageous to provide orthodonticbracket holders in sets with each holder in the set being dedicated topositioning a bracket on a particular tooth, and each holder having aheight gauge set to a fixed height that corresponds to the height atwhich a bracket is to be positioned on the tooth corresponding to theholder.

IP Archwire Sets

The present invention is in part directed to selection of individualpatient archwires by examining the patients inner arch rather than thepatients teeth. In particular, a preferred method of archwire selectioncomprises (a) obtaining a representation of a patient's inner arch curve(a “PIAC”); (b) selecting an archwire shape based at least partially onthe PIAC representation; (c) making an initial selection of an archwiresize based at least partially on the PIAC representation; (d) selectinga final archwire size after considering something other than the PIACrepresentation; and (e) selecting an archwire to be used based on theselected archwire shape and selected final archwire size. Using the PIACrather than the occlusal or labial and buccal surfaces of the teeth forarchwire shape selection promotes shaping the teeth to the shape of thejaw bone, and gives consistent facial esthetics plus better retention ofthe treatment correction.

It is contemplated that such a method of archwire selection mayadvantageously be at least partially used as part of an automated systemfor selecting an archwire for a patient comprising: a patient internalarch curve recorder adapted to obtain a representation of the patient'sinternal arch curve; data on available archwires; and a mechanismadapted to compare an obtained representation of a patient's internalarch curve with the data on available archwires and to identify anarchwire based on any such comparison. Similarly, it may advantageouslybe used, at least in part, in a system for selecting and ordering anarchwire for a patient comprising means for selecting an archwire from aplurality of available archwires; and means for ordering the selectedarchwire from an archwire supplier; wherein the selection of an archwireis based, at least in part, on all of the following factors: thepatient's jawbone structure; a dentists preferred treatment option; andthe sizes and shapes of available archwires.

IP Bracket Sets

The present invention is in part directed to improved orthodonticmethods and apparatus that reduce the level of skill required forsuccessful treatment, reduce the amount of orthodontist time requiredfor successful treatment, and have improved retention. Moreparticularly, methods are described that involve identifying and/oranticipating undesired orientations prior to or early in treatment andselecting brackets for use during treatment that are adapted to correctsuch undesired orientations. Brackets for use in such methods are alsodescribed.

One aspect of the invention is a method of treatment involving earlycorrection or over correction of tooth orientation Other aspects relatedto early correction are: (a) early identification of mis-oriented (thosehaving undesired orientations) teeth in regard to the types of rotationsthat would be required to rotate each of such teeth form its properorientation to its actual orientation; and (b) the use of shapedarchwires to identify mis-oriented teeth. The use of shaped archwires tocheck tooth orientation can also be used after initial treatment todetermine whether the desired amount of correction or over correctionhas been obtained. It is contemplated that early identification andtreatment of mis-orientations will result in better retention aftertreatment completion.

Additional aspects of the invention are: (a) the use of brackets adaptedto correct for specific types of mis-orientations and (b) the use ofvisual indicators on brackets to facilitate proper bracket selection. Itis contemplated that the use of brackets adapted to provide particulartypes of correction will minimize or eliminate the need for wire bendingduring treatment.

Yet another aspect of the invention is the use of automated methods toidentify or predict mis-orientated teeth (teeth having undesiredorientations and characterizable as being rotated relative to a desiredorientation), and/or brackets to be used with particular teeth, andpossibly to order brackets for treatment. Such automated methods arecontemplated as being necessary to make the use of the large number ofcontemplated brackets manageable, to better insure proper treatment, andto minimize the amount of brackets that need to be kept in stock.

Still another aspect of the invention is the modification of toothorientation without requiring that brackets be placed off-center on thelabial surface or requiring that the amount of material used to bond abracket to a tooth be modified from that used on other teeth.

Still another aspect of the invention is overcorrection of toothorientation such that a tooth is rotated from an undesired orientation,through a desired orientation, to a second undesired orientationcomprising tooth rotations opposite those found in the originalorientation. Overcorrecting tooth orientation is contemplated to resultin better retention as any initial tendency a tooth to move back towardsits original orientation will in fact move it closer to a desiredorientation. It is contemplated that four degrees of overcorrection mayprovide better long term orientation of teeth.

Yet another aspect of the invention is the use of two part brackets toobtain full or overcorrection of tooth orientation. Preferred bracketscomprise a base having a deep archwire receiving slot, and slot insertinserted into the archwire receiving slot to modify the angle of thebase of the slot relative to the base of the bracket. Preferred slotinserts comprise a wedge shape, the wedge being formed from two surfacesangled relative to each other where one of the surface is adapted toconform to the base of the slot. The slot insert is preferably insertedinto the slot prior to the slot receiving an archwire, and to be atleast partially held in place by the archwire.

Still another aspect of the claimed invention is a bracket repair kitcomprising at least two of each of the variety of brackets a dentist canchoose from for patient treatment. Although brackets for treatment arepreferably ordered on an as needed basis, keeping a set comprising twoof each bracket currently being used in treating the dentist's patientsallows the dentist to quickly replace lost or damaged brackets. In oneembodiment a bracket repair kit may comprise two brackets of every typeof bracket typically used by the dentist for treatment, while anotherembodiment may be limited to brackets that previously been used inpatient treatment, are currently in use on the dentist's patients,and/or that are anticipated to be used on current patients. It iscontemplated that when a bracket from the kit is used, a replacementbracket for the kit will be ordered along with the next order for a IPBracket Set. Reorder brackets would be included in the next patientshipment, leaving at least one replacement bracket in the repair kit asthe dentist waits for the next shipment to arrive.

Various objects, features, aspects and advantages of the presentinvention will become more apparent from the following detaileddescription of preferred embodiments of the invention, along with theaccompanying drawings in which like numerals represent like components.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a bracket, archwire, and tooth assembly.

FIG. 2A is a schematic illustrating horizontal positioning of thebracket of FIG. 1 relative to the tooth of FIG. 1.

FIG. 2B is a schematic illustrating vertical positioning of the bracketof FIG. 1 relative to the tooth of FIG. 1.

FIG. 2C is a schematic illustrating orientation of the bracket of FIG. 1relative to the tooth of FIG. 1.

FIG. 3 is a perspective view of a prior art bracket holding tweezer.

FIG. 4 is a perspective view of a preferred apparatus embodying theinvention.

FIG. 4A is a side view of the apparatus of FIG. 4.

FIG. 4B is a top view of the apparatus of FIG. 4.

FIG. 4C is a front view of the apparatus of FIG. 4.

FIG. 4D is a back view of the apparatus of FIG. 4.

FIG. 4E is a detail view of the gripping mechanism portion of theapparatus of FIG. 4.

FIG. 4F is a detail view of a vertical indicator portion of theapparatus of FIG. 4.

FIG. 4G is a detail view of a height indicator portion of the apparatusof FIG. 4.

FIG. 4H is a view of a holder de-biasing portion of the apparatus ofFIG. 4.

FIG. 5 illustrates a first use of the apparatus of FIG. 4.

FIG. 6 illustrates a second use of the apparatus of FIG. 4.

FIG. 7 illustrates a third use of the apparatus of FIG. 4.

FIG. 8 illustrates a fourth use of the apparatus of FIG. 4.

FIG. 9 illustrates a fifth use of the apparatus of FIG. 4.

FIG. 10 depicts a set of apparatus where each member of the set ischosen to match the height requirements for a particular tooth of apatient to be treated.

FIG. 11 is diagram of a first method of archwire selection.

FIG. 12 is a top view of a patient's study model.

FIG. 13 is a top view of an image of a patient's teeth and arch.

FIG. 14 is a top view of a tapered archwire.

FIG. 15 is a top view of a square archwire.

FIG. 16 is a top view of an ovoid archwire.

FIG. 17 is a top view of a translucent sheet bearing representations ofvarious different sized tapered archwires.

FIG. 18 is a top view of a translucent sheet bearing representations ofvarious different sized square archwires.

FIG. 19 is a top view of a translucent sheet bearing representations ofvarious different sized ovoid archwires.

FIG. 20A is a top view of a translucent sheet bearing archwirerepresentations superimposed on a patient's study model to compare therepresentations to the patient's PIAC.

FIG. 20B is a top view of a translucent sheet bearing archwirerepresentations being compared to the curve formed by the labial andbuccal surfaces of a patient's teeth.

FIG. 21A is a dimensioned view of a small tapered, lower archwire.

FIG. 21B is a dimensioned view of a medium, tapered, lower archwire.

FIG. 21C is a dimensioned view of a non-extraction, tapered, lowerarchwire.

FIG. 21D is a dimensioned view of a medium, square, lower archwire.

FIG. 21E is a dimensioned view of a large, square, lower archwire.

FIG. 21F is a dimensioned view of a small ovoid, lower archwire.

FIG. 21G is a dimensioned view of a medium, ovoid, lower archwire.

FIG. 21H is a dimensioned view of a first non-extraction, ovoid, lowerarchwire.

FIG. 21I is a dimensioned view of a second non-extraction, ovoid, lowerarchwire.

FIG. 22A is a dimensioned view of a small, tapered, upper archwire.

FIG. 22B is a dimensioned view of a medium, tapered, upper archwire.

FIG. 22C is a dimensioned view of a non-extraction, tapered, upperarchwire.

FIG. 22D is a dimensioned view of a medium, square, upper archwire.

FIG. 22E is a dimensioned view of a large, square, upper archwire.

FIG. 22F is a dimensioned view of a small, ovoid, upper archwire.

FIG. 22G is a dimensioned view of a medium, ovoid, upper archwire.

FIG. 22H is a dimensioned view of a first non-extraction, ovoid, upperarchwire.

FIG. 22I is a dimensioned view of a second non-extraction, ovoid, upperarchwire.

FIG. 23A is a perspective view of a properly aligned tooth.

FIG. 23B is top view of the tooth of FIG. 23A.

FIG. 23C is top view of the tooth of FIGS. 23A and 23B shown with amesial rotation

FIG. 23D is top view of the tooth of FIGS. 23A and 23B shown with adistal rotation.

FIG. 23E is top view of the tooth of FIGS. 23A and 23B shown with alabial root rotation.

FIG. 23F is top view of the tooth of FIGS. 23A and 23B shown with alingual root rotation.

FIG. 23G is top view of the tooth of FIGS. 23A and 23B shown with amesial crown rotation.

FIG. 23H is top view of the tooth of FIGS. 23A and 23B shown with adistal crown rotation.

FIG. 24 is an illustration of tooth position being divided into fourquadrants.

FIG. 25 is a front view of a bracket comprising visual indicators.

FIG. 26 is an illustration of the torque components that a particularbracket might provide.

FIG. 27A is a top side view of a bracket.

FIG. 27B is a right side view of the bracket of FIG. 27.

FIG. 27C is a bottom side view of the bracket of FIG. 27.

FIG. 27D is a left side view of the bracket of FIG. 27.

FIG. 27E is a side view of a bracket.

FIG. 27F is a side view of a bracket.

FIG. 27G is a front view of a bracket.

FIG. 27H is a front view of a bracket.

FIG. 27I is a front view of a bracket.

FIG. 27J is a front view of a bracket.

FIG. 28A is a perspective view of a multi-piece bracket assemblycomprising a bracket and a slot insert.

FIG. 28B is a side, exploded view of the assembly of FIG. 28A.

FIG. 28C is a perspective view of the insert of FIG. 28A.

FIG. 28D is a side view of the bracket of FIG. 28A.

FIG. 29 is an illustration of a chart that can be used to identifymesially and distally rotated teeth.

FIG. 30 is a table identifying MS1 brackets.

FIG. 31 is a view of a patient characteristic form.

FIG. 32 is a view of a diagnosis assistance form.

FIG. 33 is a view of an appliance design form.

FIG. 34 is a view of a treatment history form.

FIG. 35 is a view of a patient picture presentation form.

FIG. 36 is a view of a window showing an enlarged view of a picture fromthe form of FIG. 35.

DETAILED DESCRIPTION

GMPOI Holder

In FIG. 4, a preferred holder, positioning, and alignment apparatus 100comprises a bracket holder 500, bracket/gripping member position andorientation indicator (hereinafter GMPOI) 600, and a bracket verticalposition indicator/height gauge 700. Both GMPOI 600 and gauge 700 servedual purposes as each can be used to both position and orient a bracket.

Referring to FIGS. 4A-4H, holder 500 comprises a pair of elongatedmembers 510 and 510′ placed in an adjacent lengthwise relationship withone another, each member having a first end part 520 and 520′ and asecond end part 530 and 530′, the first end part forming a grippingmechanism 540, and the second end parts coupled together to form ahandle 550. As with the tweezers of FIG. 3, the holder 500 is apre-tensioned or cross-over type having a gripping mechanism 540comprising a jaw which is held in the closed position by tension formedby the shape of the tweezers, in particular by the cross-over portion560. The gripping jaw 540 includes the first end parts 520 and 520′ ofthe members 510 and 510′, includes gripping surfaces 570 and 570′ havingfront edges 580 and 580′ that are adapted for and used to grip the tiewings of an orthodontic bracket. The front edges 580 and 580′ of thegripping jaws are inclined relative to a line L1 passing through thelength of holder 500. In a preferred embodiment, a de-biasing portion551 of either or both of members 510 and 510′ is thinner than theremainder of the member so as to decrease the amount of force requiredto separate gripping surfaces 570 and 570′. In FIG. 4H thickness T2 isless than thickness T1, the thickness of a majority of member 510′.Holder 500 is preferably formed from elongated planar pieces ofstainless steel.

It should be noted that the actual structure of holder 500 is notlimited to that shown. Other contemplated embodiments of holder 500 willdiffer from the shown embodiment in regard to the materials used, form,and/or principle of operation. As would be obvious to one of averageskill in the art, the methods and the position and orientationindicators disclosed herein are suitable for use with a large variety ofholders.

Gripping member position and orientation indicator (GMPOI) 600 ispreferably a planar member 610 with a parallelogram shape positionedbetween edges 580 and 580′ and handle portion 550 as shown in FIG. 4F.It is preferred that member 610 be angled relative to the body ofapparatus 100 such that the forward and rear edges 613 of the member areparallel with the edges 580 and 580′ of holder 500. In FIG. 4F lines L3and L4 illustrate the relative orientation of forward edge 613 and 580in a preferred embodiment. As can be seen, lines L3 and LA are parallelto each other, and are not perpendicular to the centerline L1 of holder100. Member 610 preferably extends above and/or below the grippingsurfaces 570 and 570′, and more preferably above and/or below the handleportion 550. Member 610 is preferably positioned within 0.5 inches ofthe forward edges 580 and 580′. Member 610 is preferably perpendicularto the plane formed by edges 580 and 580′. Top and bottom edges 611 and612 of member 610 are preferably parallel to the centerline of holder100 as shown by lines L1 and L2 of FIG. 4F.

Preferred embodiments will comprise horizontal position indicators aswell as vertical position indicators. In the embodiment shown, GMPOI 600functions both as a position indicator and an orientation indicator.However, it is contemplated that alternative embodiments may utilizeseparate and/or additional indicators.

Vertical indication indicator 700 comprises a height gauge formed bytooth occlusal surface contacting member 710, and height indicationmember 720 as shown in FIG. 4G. The distance D1′ between members 710 and720 is preferred to be fixed during formation of holder 100 and tocorrespond to a desired distance D1 to allow proper vertical positioningof bracket 10 relative to the occlusal plane P1. Members 710 and 720 arepreferred to be parallel to each other. It is also preferred that edges711 and 721 be adapted to fit within bracket's archwire receiving slots(see FIGS. 8 and 9). Surface contacting member 710 is preferred to besubstantially longer than surface contacting member 720 to permit member710 to contact the occlusal surface of a tooth while edge 721 of member720 is inserted into a bracket's archwire receiving slots.

In preferred embodiments member 720 will comprise a wire 722, possiblyin the form of a loop, with edge 721 being a linear portion of wire 722.Forming edge 721 from wire 722 helps prevent inadvertent movement of abracket when edge 721 is inserted into the bracket's archwire receivingslots, particularly when those slots are angles. With a wire, bracketholder 100 can rotate around edge 721 and have a minimal impact on abracket during such a rotation. A tool which cannot be rotated aroundedge 721 that is inserted into an angled archwire receiving slot willitself be in a non-horizontal position, and thus cannot be used toaccurately position the bracket because member 710 will be angled upwardor downward.

It is preferred that member 710 be parallel to the line L5 formed bypoints 591 and 592, and be parallel to or coplanar with member 610.Points 591, the point at which members 510 and 510′ cross, and 592, thecenter of the end of the handle portion of the holder, are readilyidentifiable when looking at apparatus 100. As such, points 591 and 592provide a convenient means for using apparatus 100 to provide a visualindication of the orientation of members 710 and 610. Consequently, ifeither member 610 or 710 is inserted into a bracket's archwire receivingslots (as shown in FIGS. 7 and 9), the line extending between points 591and 592 provides an indication of the orientation of the bracket, and,because of the length of such a line, allows for finer adjustments tothe orientation of a bracket than is possible by simply viewing thebracket while it is being gripped by the holder. bracket installation.FIG. 10 illustrates such a preloaded set of bracket holders 100A-100Epre-loaded with brackets 10A-10E. It is contemplated that preferred setsmay comprise 20-24 holders, one for each of 20-24 brackets to bepositioned. It is also contemplated that the brackets and holders ofsuch a set may be arranged in an order related to the order in which thebrackets are to be installed, or an order related to the relativepositioning of the patients teeth so as to facilitate identification ofthe appropriate holder to use for each tooth.

It is contemplated that one method for using such a set for coupling aplurality of orthodontic brackets to a plurality of teeth would includeproviding a plurality of bracket holders, each holder having a graspingmember adapted to receive and hold a bracket; providing a plurality ofbrackets; and, prior to coupling any one of the brackets to a tooth,causing each bracket holder to receive and hold a bracket. Such a methodwould preferably also include, prior to coupling any one of the bracketsto a tooth, arranging the bracket holders in an order at least partiallydependent on the order in which the brackets are to be installed, or atleast partially dependent on the relative positions of the teeth towhich the brackets are to be coupled.

Each patent or other publication referenced above is incorporated hereinby reference in its entirety.

IP Archwire Sets

Referring to FIG. 11, a method of archwire selection comprises: step1111, obtaining a representation of a patient's inner arch curve (a“PIAC”); step 1120, selecting an archwire shape based at least partiallyon the PIAC representation; step 1130, making an initial selection of anarchwire size based at least partially on the PIAC representation; step1140 selecting a final archwire size after considering something otherthan the PIAC representation; and step 1150, selecting an archwire to beused based on the selected archwire shape and selected final archwiresize. Using the PIAC rather than the occlusal or labial and buccalsurfaces of the teeth for archwire shape selection promotes shaping theteeth to the shape of the jaw bone and gives consistent facial estheticsplus better retention of the treatment correction.

A PIAC, as the term is used herein, is the curve formed by the jaw-bonestructure of the patient. It is contemplated that the PIAC is bestrepresented by the curve formed where the surface formed by thepatient's gums transitions from the surface formed by the portion of thegums covering the patient's upper or lower arch to the surface formed bythe portion of the patient's gums covering the bases of the interiorsurfaces of the patient's teeth. As a patient has upper and lowerarches, the PIAC corresponding to the upper arch will be referred to asthe “upper PIAC”, and the PIAC corresponding to the lower arch will bereferred to as the “lower PIAC”. In instances herein where what is beingdiscussed can be applied to either or both the upper PIAC and lowerPIAC, the acronym “PIAC” will not be preceded by either the word upperor lower. A similar convention will be followed in regard to the term“arch” as well. The PIAC will typically be visible if one views an imageor study model of the patient's teeth and arch.

Referring to FIGS. 12 and 13, obtaining a representation 1110 of thePIAC may be accomplished in a number of ways including but notnecessarily limited to obtaining a study model 1100A of the patient'steeth and arch, obtaining an image 1100B of the patient's teeth andarch, and obtaining an electronic representation (not shown) of thepatient's teeth and arch. Although the use of a study model 1100A orimage 1100B is advantageous for manual selection methods, the use ofalternative representations may be more advantageous for automatedmethods. If manual selection methods are to be used, it will generallybe desirable that PIAC representation 1110 be visible. However, all thatis required of a PIAC representation 1110 is that it be comparable to arepresentation of one or more archwires. As such, the type ofrepresentation used will be at least partially dependent on the mannerin which comparisons are to be made.

Selecting an archwire shape will generally comprise comparing the PIACrepresentation 1110 to existing archwire shapes and selecting thearchwire shape that most closely corresponds to the PIAC 1110. It iscontemplated that a larger number of patients will have PIAC shapes thatcorrespond to one of three archwire shapes, square, tapered, and ovoid.FIGS. 14-16 depict three archwires 1200 having the three shapes, squarearchwire 1210, tapered archwire 1220, and ovoid archwire 1230. It iscontemplated that arch shapes other than those shown in FIGS. 14-16maybe used, but that the three shown provide the best fit to reduce themanufacturing and inventory needed to use preformed shapes and sizes inprivate practice.

It is preferred that selection of an archwire shape be accomplished bycomparing a representation of an available archwire to the PIACrepresentation 1110. The use of an archwire representation forcomparison in place of an actual archwire is thought to advantageous, ifnot actually required, for use in automated archwire selection methods.The use of an archwire representation also provides advantages in manualselection methods as such a representation is generally cheaper than anactual archwire, maintaining the integrity of the representation isgenerally easier than doing the same for an archwire, and storing therepresentation is easier than storing the archwire. In less preferredmethods, selection of an archwire shape may be accomplished by simplyviewing the PIAC representation to determine its shape, the determinedshape becoming the selected archwire shape.

Referring to FIGS. 17-19, it is contemplated that, particularly formanual methods, providing one or more sets 1300 of archwirerepresentations (1310A-1310C, 1320A-1320B, 1330A-1330D) on a transparentor translucent sheet 1301 facilitates selection of an archwire shape asthe members of the collection can be visually compared to the PIAC bysuperimposing the individual archwire representations on the PIACrepresentation as shown in FIG. 20A. A given set may compriserepresentations of each shape of archwire, representations of differentsized archwires of a given shape as was done in FIGS. 17-19, or acombination of different archwire shapes and sizes. A given set may alsoinclude variations on sizes that correspond to treatment options such asnon-extraction vs. extraction. FIG. 17 shows a set 1300 of taperedshaped archwire representations 1310A-1310C, with 1310A being a smalltapered archwire, 1310B being a medium tapered archwire, and 1310C beinga non-extraction tapered archwire. FIG. 18 shows a set 1300 of squareshaped archwire representations 1320A-1320B, with 1320A being a mediumsquare archwire, and 1320B being a large square archwire. FIG. 19 showsa set 1300 of ovoid shaped archwire representations 1330A-1330D, with1330A being a small ovoid archwire, 1330B being a medium ovoid archwire,1330C being a first non-extraction ovoid archwire, and 1330D being asecond non-extraction ovoid archwire.

Selecting an archwire size will generally comprise comparing the PIAC1110 to existing archwire sizes (see FIG. 20A) and selecting thearchwire size that most closely corresponds to the PIAC 1110. Thisinitial selection will often be done simultaneously with the selectionof the archwire shape by comparing various archwire representations tothe PIAC representation 1110. After an initial size selection is made, afinal selection will be made based on criteria other than the PIAC 1110.Typically this will involve comparing various archwire representationswith the curve 1120 formed by the outside (labial and buccal) surfacesof a patient's teeth (see FIG. 20B and FIG. 12) and determining whichrepresentation best corresponds to that curve. If a particular treatmentoption is to be chosen, the comparison may be limited to a subset ofarchwire sizes that correspond to the chosen treatment. Thus, on thesame patient, one diagnosis (non-extraction) may require a larger sizethan the patient's original naturally determined, arch size. In anothertreatment choice, the arch shape and size may be maintained, and inothers, the shape and size may be constricted.

As an example, study model 1100A may be that of a patient who wants thewider smile that a non-extraction treatment could bring. Having obtainedstudy model 1100A, a dentist would then pull out one or more transparentsheets 1301 bearing representations (1310-1330) of the archwires(1210-1230) available to the dentist. The dentist would first determinethe appropriate archwire shape to be used by superimposing the differentarchwire representations on the study model to see which representationbest fit the PIAC reproduced by the study model. For the sake of thisexample, we will assume that a small ovoid archwire best fits thepatient's PIAC. Having determined the shape and that the final size willnot be smaller than the small ovoid, the next step is to determine whichsize is appropriate. Since a non-extraction plan is to be followed, thesmall/first and medium/second non-extraction representations will besuperimposed on the study model so that the dentist can visuallydetermine which best fits the curve that will be formed when a wire ismounted to brackets coupled to the patient's teeth.

It is contemplated that the method of archwire selection discussedherein is particularly well adapted for implementation in an automatedsystem 1400 for archwire selection as shown in FIG. 23. It iscontemplated that such a system 1400 would beneficially comprise apatient internal arch curve 1410 recorder adapted to obtain arepresentation 1415 of a patient's internal arch curve; data 1420 onavailable archwires; and a mechanism 1430 adapted to compare an obtainedrepresentation 1415 of a patient's internal arch curve with the data1420 on available archwires and to identify an archwire based on anysuch comparison. Such a system 1400 would also preferably include means1440 for accepting a treatment diagnosis 1450 for the patient. It isalso preferred that either the curve recorder 1410 or some other meansbe used to provide additional data 1460 (such as current position,orientation, shape, and size) on the patients teeth. It is alsopreferred that such a system be integrated into a system 1500 (see FIG.24) that facilitates the ordering of the selected archwire and otherorthodontic hardware to minimize or eliminate the need for adentist/orthodontist to stock archwires. Such a system will generallycomprise means 1510 for selecting an archwire from a plurality ofavailable archwires, and means 1520 for ordering the selected archwirefrom an archwire supplier. In such a system 1500, the selection of anarchwire will likely be based, at least in part, on all of the followingfactors: the patient's jawbone structure; a dentists preferred treatmentoption; and the sizes and shapes of available archwires.

A patient internal arch curve recorder 1410 adapted to obtain arepresentation of a patient's internal arch curve 1415 may comprise amodern imaging system capable of providing the required electronicrepresentation directly. Alternatively, such a recorder 1410 may simplycomprise a scanner or digital camera which digitizes a representation(such as a study model or physical image) obtained through other means.Similar methods may be used to obtain additional data 1460 on thecurrent state of the patient's teeth such as current position,orientation, shape, and size.

The data 1420 on available archwires is preferably a database ofavailable archwires with sufficient data on each available archwire topermit comparison, primarily in regard to shape, with the patient'sPIAC, the curve formed by the outside (labial and buccal) surfaces ofthe patients teeth, and the desired treatment option. In some instances,such data 1420 may be provided in electronic form directly from one ormore archwire manufacturers. In other instances, such data may beobtained directly from examination of actual archwires.

A mechanism 1430 adapted to compare an obtained representation of apatient's internal arch curve 1415 with the data 1420 on availablearchwires may use one or more known comparison methods adapted forcomparing curves and/or data sets. It is contemplated that such amechanism 1430 may operate to identify an ideal curve based on thepatients PIAC, the current state of the patient's teeth, the desiredtreatment option, and the next step to be performed in following thattreatment option. Once such an idealized curve is identified, it may becompared to the data available on available archwires to select anavailable archwire best adapted to accomplish the next step of thetreatment. Alternatively, such a mechanism 1430 may simply plug all thedata available on the patient and the available archwires into a complexalgorithm that will identify the archwire to be used. Regardless of themethod used, the results of the comparison need to be communicated tothe dentist/orthodontist. It is preferred that the results becommunicated directly to the dentist. The results may be communicatedindirectly if the system is integrated with an ordering system such thatthe dentist is notified by receipt of an archwire, but such a system maybe less than desirable if possible errors in treatment are to beminimized.

Any means 1440 for accepting a treatment diagnosis 1450 for the patientthat facilitates the use of the diagnosis in selecting an archwire maybe used. Such means 1440 will typically include the use of a keyboardand monitor to accept input and provide verification of correct input tothe dentist. Alternatively, other means may be used such as systemsdesigned to accept voice input and to provide audio confirmation and/oroutput.

Integration into a system 1500 that facilitates the ordering of theselected archwire and other orthodontic hardware is preferred in orderto minimize or eliminate the need for a dentist/orthodontist to stockarchwires. Ideally, the dentist/orthodontist would need to supply only atreatment diagnosis to the system, and facilitate the system's obtainingdata on the patients teeth and jaw bone structure, confirm that anarchwire or set of archwires is to be ordered, and then wait fordelivery of the ordered archwire(s). Although stocking of some archwiresmay facilitate a just-in-time system of inventory in which inventory isreplaced as used, it is preferred that little or no inventory ofarchwires be maintained and that archwires be obtained on an as-neededbasis. Although there will generally be a delay between thedetermination of the archwire to be used and the dentists receipt of thearchwire and/or use of it on the patient, such a delay is considered tobe acceptable in light of the savings to be achieved by reducing oreliminating the dentist's inventory of archwires. Such a saving becomeseven more significant as the number of shapes, sizes, and types ofavailable archwires increases. Reference to FIGS. 21A-21I and 22A-22Iprovide an indication of the impact of such an increase when oneconsiders that in many instances a single archwire shape and size mayhave been previously used and stocked in place of the archwires shown.

Although the system and method discussed are generally applicableregardless of the archwire shapes and sizes available, it iscontemplated that having the archwires shown in FIGS. 21A-21I and22A-22I may be advantageous. The pictured set of archwires iscontemplated to be a set of archwires that embodies a desirable balanceof the advantages and disadvantages relating to the number, size, andshape of archwires available. It is contemplated that the archwiresshown may also comprise T and/or keyhole loops and or loops having othershapes. In such instances the pictured archwires would be illustrativeof the shape of such archwires as viewed with any such loops projectingdirectly into or out of the page.

Orientation Correction

Treatment of tooth orientation is preferably begun by identifyingmis-oriented (those having undesired orientations) teeth in regard tothe types of rotations that would be required to rotate each of suchteeth form its proper orientation to its actual orientation.Particularly if being done in conjunction with correction of toothposition, such identification is preferably done prior to beginningtreatment or early during treatment in a manner to be described. Afteridentifying mis-oriented teeth, tooth orientation is preferablycorrected through the use of rotation brackets such as those describedfurther on. It is contemplated that the use of brackets adapted toprovide particular types of correction will minimize or eliminate theneed for wire bending during treatment. The use of rotation bracketsduring treatment is best accomplished if a bracket be selected for everytooth having (or that will have) an undesired orientation where thebracket is adapted to apply torque to the tooth to cause it to rotatetowards a desired orientation. During treatment, the identificationmethods described can be used to very that correction of orientation isoccurring and/or is complete.

In many instances, treatment of tooth orientation will preferablyinvolve overcorrection of tooth orientation to achieve better retention.Overcorrecting tooth orientation involves rotating a tooth from anundesired orientation, through a desired orientation, to a secondundesired orientation comprising tooth rotations opposite those found inthe original orientation. If overcorrected, any initial tendency for atooth to move back towards its original orientation will in fact move itcloser to a desired orientation. It is contemplated that four degrees ofovercorrection may provide better long term orientation of teeth.

Orientation and Torque

The orientation of a particular tooth can be described as one or morerotations about at least one of three orthogonal axis intersecting atthe center of the tooth. Axis A1, A2, and A3 in FIG. 23A are an exampleof such axis. A tooth can be characterized as having the following“surfaces” (each “surface” being a portion of the exterior surface ofthe tooth as illustrated in FIGS. 23A and 23B): mesial 2201, distal2202, lingual 2203, labial 2204, and occlusal 2205, and can also becharacterized as including a crown 2206 and a root 2207. The portions ofa tooth 2200 corresponding to such surfaces are illustrated in FIGS. 23Aand 23B. In some instances a given surface will be referred to by itsname alone such as “the mesial” rather than “the mesial surface”. Thevarious surfaces of a tooth are determined by where the surfaces wouldbe on a properly aligned tooth (as shown in FIGS. 23A and 23B) ratherthan where they actually are. FIG. 23C illustrates the location of thevarious surfaces (2201-2204) for the tooth 2200 of FIGS. 23A and 23Bassuming tooth 2200 has been rotated around axis A1. The arrow drawn onthe occlusal surface 2205 of tooth 2200 points to the same point ontooth 2200 in both FIGS. 23B and 23C to help illustrate the 90 degreerotation of tooth 2200 around axis A1 between FIGS. 23B and 23C. Alsoshown in FIGS. 23A-23C are line J1 indicating the curve that wouldnormally be formed by other teeth and area B1 which indicates apreferred mounting position for a bracket, i.e. in the center of labialsurface 2204. In contrast, the “facial surface” 2208 of a tooth is usedto refer to the portion of the tooth closest to the face (i.e. theposition of the labial surface in a non-rotated tooth) for both rotatedand non-rotated teeth. The facial surface is also the portion of a toothclosest to an unbent, shaped archwire positioned adjacent the teeth.

A tooth rotated from its proper/desired orientation around axis A1, suchas tooth 2200 in FIG. 23C, can be described in relation to how theactual position of the labial surface 2204 (or area B1) relative to itsproper position. As an example, tooth 2200 in FIGS. 23C can be describedas having a mesial rotation as labial surface w204 is rotated aroundaxis A1 towards the proper position of mesial surface w201. If, as shownin FIG. 23D, labial surface 2204 had been rotated in an oppositedirection around axis A1, tooth 2200 could be described as having adistal rotation because the labial surface would be rotated around axisA1 towards the proper position of the distal surface 2202. Correctingfor mesial rotation would require application of distal torque andcorrecting for distal rotation would require application of mesialtorque.

A tooth rotated from its proper orientation around axis A2, such astooth 2200 in FIG. 23E or FIG. 23F, can be described in relation to theposition of the occlusal surface 2205 relative to the tongue or lips. Iftooth 2200 is rotated around axis A2 as shown in FIG. 2E such thatocclusal surface 2205 is rotated towards the tongue, tooth 2200 may bedescribed as having lingual rotation. Similarly, if tooth 2200 isrotated around axis A2 as shown in FIG. 23F such that occlusal surface2205 is rotated towards the lips, tooth too may be described as havinglabial rotation. To help distinguish rotations around axis A2 from thoseof axis A1 and A3, rotations around axis A2 may be described as “labialroot rotation” and “lingual root rotation”. Correction for lingual rootrotation would require application of labial torque (sometimes referredto as “labial root torque”), and correcting for labial root rotationwould require application of lingual torque (sometimes referred to as“lingual root torque”).

A tooth rotated from its proper orientation around axis A3, such astooth 2200 in FIG. 23G or FIG. 23H, can be described in relation to theposition of the occlusal surface 2205 or crown 2206 relative to mesialor distal surfaces. If tooth 2200 is rotated around axis A3 as shown inFIG. 23G such that crown 2206 is rotated towards the mesial, tooth 2200may be described as having mesial angulation, mesial crown angulation,or mesial crown rotation. The phrase “mesial rotation” is not usedbecause of the possibility of confusion with a rotation around axis A1.Similarly, if tooth 2200 is rotated around axis A2 as shown in FIG. 23Hsuch that crown 2206 is rotated towards the distal, tooth 2200 may bedescribed as having distal angulation, distal crown angulation, ordistal crown rotation. The use of “distal rotation” is preferablylimited to rotations around axis A1.

Having brackets adapted to apply torque to a tooth to cause it to rotatetowards a desired orientation requires a larger number of differenttypes of brackets than is typically used. In addition to havingvariations based on the types of rotations to be corrected for, therewill preferably be variations based on positions of teeth within themouth. Referring to FIG. 24, each tooth in a persons mouth can becharacterized as being in one of four quadrants Q1-Q4. The teeth shownin FIG. 24 are shown as if one were looking outward from inside aperson's mouth. In FIG. 24, quadrant Q1 is the upper right quadrant, Q2is the upper left quadrant, Q3 is the lower left quadrant, and Q4 is thelower right quadrant.

Bracket Indicators

Having a large variety of brackets makes it advantageous to providevisual indicators on the brackets to help identify the tooth positionand correction associated with each bracket. Such indicators wouldprovide the person selecting the bracket with an indication as to whichbracket is appropriate for a desired task. Preferred brackets willcomprise indicators that indicate both the quadrant of teeth it isappropriate for and the type of correction it provides. The type ofcorrection is preferably specified either in regard to the type ofrotation use of the bracket will cause, or the type of tooth rotation itcorrects, or some combination thereof.

A preferred set of indicators comprises a set of three colored dotspainted or otherwise applied to a bracket's surface, and more preferablyto the wing ties. A preferred bracket using three colored indicator dots(2425A-2425C) is shown in FIG. 25. In FIG. 25, bracket 2420 comprisesbase 2421, and stems 2422 and 2423. Stems 2422 and 2423 each comprisetwo tie wings (2422A, 2422B, 2423A, and 2423B) and an archwire receivingslot (2422C and 2423C). For the bracket 2420 of FIG. 25, tie wings 2422Aand 2422B are mesial tie wings and 2423A and 2423B are distal tie wings,brackets 2423A and 2424A are occlusal tie wings and brackets 2423B and2224B are gingival tie wings. Dot 2425A on the distal gingival tie wingpreferably indicates the quadrant the bracket is appropriate for withblack indicating upper right quadrant Q1, green indicating upper leftquadrant Q2, white indicating lower left quadrant Q3, and red indicatinglower right quadrant Q4. Dots 2425B and 2425C are used in conjunction toindicate the tooth of correction provided. Correction relative to axisA1 is preferably indicated in relation to the orientation of the toothto which it is to be applied with red indicating the bracket is for usewith a tooth having mesial rotation and green indicating the bracket isfor use with a tooth having distal rotation. Correction relative to axisA2 is indicated based on the type of torque the bracket will apply tothe tooth with black indicating that the bracket will apply linqual roottorque and white that it will apply labial root torque. A yellow dot isused to indicate that the bracket provides correction for distal crownangulation. As an example, a bracket suitable for use on an upper rightquadrant tooth having mesial rotation and needing labial root torquewould have black on the distal-gingival tie wing (dot 2425A) indicatingthat the bracket is for the upper right quadrant, and red and white dotson the mesial tie wing (dots 2425B and 2425C) to designate the mesialrotation and labial root torque. It is contemplated that non-combinationbrackets (brackets that do not provide for rotations about multipleaxis) may have fewer dots than combination brackets (brackets that doprovide for rotations about multiple axis).

Rotation Brackets—General

As shown in FIG. 26, the torque T a given bracket applies to a tooth itis mounted on when coupled to an archwire can be described as the sum ofseveral component torques such as a combination of torques T1-T6 aboutaxis A1-A3. It is preferred that mounting brackets be positioned in thecenter of the facial surface of each tooth rather than offsetting theposition of the brackets to apply torque to a tooth. As such, torquesT1-T2 are preferably obtained by angling the base surface of thearchwire receiving slot such that one side of the slot is effectivelydeeper than the other side of the slot as shown in FIGS. 27A-27D, or,less preferably, by making one side/tie wing higher than the other. Itis contemplated that angling the base of the slot can be accomplishedsimply by cutting one side of the slot deeper than the other, or, morepreferably, through the use of a multi-piece bracket assembly comprisinga bracket and a slot insert. Referring to FIGS. 27E and 27F, torques T5and T6 are obtained by making one side of the archwire receiving slot(or buccal tube) higher than the other. Alternatively, a bracket adaptedto provide no torque or one or more of torques T1-T4 may be mounted asshown in FIGS. 27G and 27G to achieve the same affect. It iscontemplated that the bracket holder described hrein is particularlywell adapted for mounting brackets in such a fashion as it include avisual indicator that helps determine/set the orientation of thebracket. Referring to FIGS. 27I-27K, torques T3-T4 are possibly obtainedby angling the tie wings and archwire receiving slot (or buccal tube)relative to the base such that the archwire receiving slot (or buccaltube) will not be parallel to a tooth's occlusal surface when coupled toa tooth and/or the lower and upper wings are at different heightsrelative to the base of the bracket and surface of a tooth to which itis mounted.

In many instances treatment causes the crowns of teeth to move outwardas the crowns are not anchored as the roots are. It is contemplated thatthis tendency can be countered using brackets adapted to apply labialroot torque, i.e. a torque that tends to rotate the roots of a toothtowards the patient's lips and the crown of the tooth towards theinterior of the patient's mouth. The bracket of FIGS. 27J and 27K areparticularly well adapted for this purpose as the angle of the slot willrequire a slight twist in an archwire being inserted into it. In such aninstance the archwire is biased to try and untwist and, in that manner,applies the desired torque to a tooth.

It is contemplated that the use of brackets adapated in the describedmanner will eliminate or decrease the need to place brackets off-centeron the labial surface or requiring that the amount of material used tobond a bracket to a tooth be modified from that used on other teeth inorder to modify tooth orientation.

Rotation Bracket—Multi-Piece Assembly

Referring to FIG. 28A-28D, a preferred bracket assembly comprises abracket 2720 and an archwire receiving slot insert 2750 inserted intoslot 2724 of bracket 2720. The bracket 2720 and insert 2750 are part ofa multi-part bracket assembly adapted to apply torque to a patient'stooth so as to obtain full or overcorrection of tooth orientation. Slot2724 is preferably cut deeper than slots of standard bracket so as toallow room for insertion of insert 2750.

Insert 2750 preferably comprises a wedge shape, the wedge being formedfrom two surfaces 2751 and 2752 angled relative to each other wheresurface 2752 is adapted to conform to the base/bottom surface 2724C ofthe slot 2724. The slot insert 2750 is preferably inserted into the slotprior to the slot receiving an archwire, and to be at least partiallyheld in place by such an archwire once the archwire is tied in place. Itis contemplated that, once tied, the archwire will hold the insert 750in place and will also cover insert 2750 so as to hide it from view andmaintain any aesthetic qualities of the bracket. Insert 2750 preferablyalso comprise lips/collars 2753 and 2754 that project outward fromsurface 2752 to deter insert 2750 from sliding along surface 2724C ofslot 2724 once positioned within slot 2724. Insert 2750 preferably alsocomprises a removable tab 2755 adapted to facilitate handling of insert2750 during its placement within slot 2724. In preferred embodiments tab2755 will extend outward from one end of insert 2750, will be circular,and/or will be easily separated from the rest of insert 2750 once insert2750 has been inserted into slot 2724.

Bracket 2720 preferably comprises a contoured base surface 2727 adaptedto be bonded to a tooth, the contour of surface 2727 being such as tobetter conform to the shape of the surface of a tooth to which it isbeing mounted than would a flat base surface. In preferred embodiments,base surface 2727 is at least partially cylindrical and has a radius ofR inches. Bracket 2720 preferably also comprises grooves 2725 or otherfeatures that reduce the area of surface 2727 such that the bondingcharacteristics of bracket 2720 are similar as those for metalappliances.

Bracket 2720 may be debonded from a tooth of a patient by having thepatient bite on something such as a cotton roll, and then grabbing themesial and distal surfaces of the bracket with a bracket debondingpliers and twisting/torquing the bracket to remove it. Once removed, anyresidual ceramic is accomplished with a diamond bur in a rotaryhandpiece or by some other suitable method.

Identification and Recordation of Rotated Teeth

Identification of rotated teeth (i.e. mis-oriented teeth) and comparisonof current tooth orientation to a desired orientation may be facilitatedthrough the use of shaped archwires such as those previously describedherein. As previously indicated, a tooth having a desired orientationhas no rotation about any of axis A1-A3 and thus has the labial surfaceas the facial surface. By holding a shaped archwire adjacent to apatients teeth (or a study model of a patients teeth, or by comparing anoverlay to such a study model) and determining whether the facialsurface of a tooth comprises portions of the mesial or distal surfaces,the tooth can be classified as having mesial or distal rotation. In manyinstances, careful comparison will show the existence of rotations thatwould not otherwise be detected. Such a comparison may be accomplishedmanually or via automated means. If automated means are used it iscontemplated that a representation of a patient's teeth will be made, atleast one of the mesial or distal surfaces identified for each tooth,that a determination will be made as to the position or orientation ofsuch identified surface relative to its proper position/or orientationor relative to the position of a shaped archwire located adjacent to theteeth, that each tooth will be classified based on its orientation andthe quadrant it is poistioned in, and that such classification will beused to identify the bracket to be used for each tooth.

In some instances manual and/or automated means may also be used todetermine tooth orientations/unwanted rotations anticipated to resultfrom a selected treatment and to identify brackets to be used to preventoccurrence of such unwanted rotations. Thus if movement of a tooth froma first position to a second position using a standard bracket (i.e. onethat doesn't provide any rotation corrections) would result in unwantedrotation of the tooth such that the tooth ends up in the desiredposition with an undesired orientation, a bracket adapted to correct forthe anticipated rotation may be used to insure that the tooth ends up inthe desired position with a desired orientation. Due to the factorsinvolved it is contemplated that selecting brackets to prevent undesiredrotations is best accomplished via automated means. Whether donemanually or via automated means, it is contemplated that bracketselection will be based on a combination of current tooth position andorientation, desired tooth position and orientation, and the treatmentto be used to move the tooth from its current position and orientationto its desired position and orientation.

Particularly if automated means are used for bracket selection, it iscontemplated that the increasing the number of brackets available foruse, where each bracket is adapted to provide a certain amount ofcorrection to a tooth's orientation, increases the number of treatmentoptions available as well as the quality of the treatment obtained.

To facilitate identify and recording mis-oriented teeth, it is preferredthat individual teeth be identified by numbers comprising two digitswith the first digit identifying the quadrant a tooth is located in, anda second digit identifying the position of the tooth relative to themiddle and front of the jaw it is attached to. As such, teeth located inthe first quadrant may be numbered 11-17 with 11 corresponding to thetooth in the quadrant closest to the middle and front of the jaw, 12 thetooth adjacent to tooth 11 in the quadrant, with the series continuingto tooth 17 being the tooth in the quadrant having the largest number ofteeth between it and tooth 11. Teeth in quadrant 2 will be similarlynumbered as 21-27, teeth in quadrant three as 31-37 and teeth inquadrant four ad 41-47. Using such numbers to identify teeth, the chartof FIG. 29 chart may be used to record whether particular teeth aremesially or distally rotated:

Bracket Identification

It is preferred individual brackets be identified by the tooth number towhich it applies, and a suffix. Contemplated suffixes include suffixesbeginning with the letter M to indicate brackets suitable for correctionof teeth that have a mesial rotation, and the letter D to indicatebrackets suitable for correction of teeth that have a distal rotation.The upper case letter D or M may be followed additional letters ordigits as shown in the following table: Suffice Meaning s The brackethas a small bonding pad. 2 The bracket is welded to a band rather thanadapted to being bonded directly to a tooth. 2tipDc The bracket iswelded to the crown with a distal crown tip. (i.e. The bracket istipped, preferably 4 degrees, relative to the band it is welded to suchthat the portion of the bracket closest to the crown is tilted towardthe distal surface of the tooth.) 2tipM The bracket is welded to thecrown with a mesial crown tip. (i.e. The bracket is tipped, preferably 4degrees, relative to the band it is welded to such that the portion ofthe bracket closest to the crown is tilted toward the distal surface ofthe tooth.) li The bracket has added lingual root torque. la The brackethas added labial root torque.

In some instances, suffixes that don't begin with M or D will be used.Some such contemplated suffixes include: CIIE A bracket designed for usewith class II elastics. CIIE2 A bracket designed for use with class IIelastics that is welded to a band. Up A molar uprighting bonded bracket.Up2c A molar uprighting bonded bracket welded to a band.

Preferred Bracket Sets

It is preferred that the treatments be determined selecting anincorporating the use of one or more of a set of preferred brackets.Such a set preferably comprises one or more of the brackets describedbelow of in the table of “MS1” brackets of FIG. 30. The set of bracketsdescribed will sometimes be described herein as McGann Series 1 bracketsor alternatively as MS1 brackets. Each MS1 bracket is identified usingthe identifications listed above, with the description includingcomments under what treatment circumstances each rotations bracket maybe advantageously used.

MS1 “mesial rotation brackets” are brackets suitable at least for (a)correction of teeth that have a mesial rotation, or (b) preventingunwanted rotation that can result from applying open coil force to thedistal of the bracket as is common in the alignment stages. MS1 mesialrotation brackets provide 4 degrees of overcorrection to eliminatefinishing bends and to improve the retention experience.

MS1 “distal rotation brackets” are brackets suitable at least for (a)correction of teeth that have a distal rotation, or (b) preventingunwanted rotation that can result from applying open coil force to themesial of the bracket as is common in the alignment stages. MS1 distalrotation brackets provide 4 degrees of overcorrection to eliminatefinishing bends and to improve the retention experience.

Upper Quadrant Brackets

A “16D” bracket is a convertible bonded bracket without distal offsetfor use in class III cases where class III elastics is the main methodto correct the occlusion. The lack of distal offset createsmesial-palatal rotation of the upper molars, favorable when correctingclass III dental. The tube can be converted to a bracket to allow forthe placement of finishing bends between the first and second molarsand/or to engage heavy rectangular archwires to the second molar.

A “15M” bracket is a mesial rotation bonded bracket with a mesial hookand an offset bonding pad. This variation is critical in pre-implantpreparation with open coils as the mesial rotation will help compensatefor the unwanted rotation of the bicuspid as the force is applied awayfrom the center of rotation. Another use of this variation is in caseswith excess spacing and minimum anchorage. Mesial forces applied to thebracket tend to create a rotation of the bicuspid, which can becompensated by the extra counter-rotation in the bracket.

A “15Ms” bracket is a mesial rotation bonded bracket with mesial hookand small bonding pad. Used on mesial rotated teeth with short clinicalcrowns, where the standard offset pad is too large for the tooth. Four(4) degrees of mesial over-correction has been added to the archwireslot. This bracket may also be used when applying open coil force to thedistal of the bracket, as is common in molar uprighting cases, but aband may be better in such cases to reduce bracket debonding. Using thisvariation is critical in pre-implant preparation with open coils. Themesial rotation will help compensate for the unwanted rotation of thebicuspid as the force is applied away from the center of rotation.Another use of this variation is in cases with excess spacing andminimum anchorage. Mesial forces applied to the bracket tend to create arotation of the bicuspid, which can be compensated by the extracounter-rotation in the bracket.

A “15M2” bracket is a mesial rotation bracket welded to a band with amesial hook and no lingual cleat. Used on teeth with “mesial rotations”that have short clinical crowns, and where heavy forces are to beapplied to the tooth. Four (4) degrees of overcorrection is added to thebracket slot to eliminate finishing bends and to improve the retentionexperience. When applying open coil force to the distal of the bracket,as is common in molar uprighting cases, a band may be better to reducebracket debonding. For pre-implant preparation of upper 6s with opencoils, it may be better to use the variation with a weld variation(15M2tipD) to also control the root angulation. The mesial rotation willhelp compensate for the unwanted rotation of the bicuspid as the forceis applied away from the center of rotation. Use this variation in caseswith excess spacing and minimum anchorage. Mesial forces applied to thebracket tend to create a rotation of the bicuspid, which can becompensated by the extra counter-rotation in the bracket. Bands may alsobe preferred when porcelain or gold crowns must be bracketed. The banddoes not break the glaze of the porcelain, although care must beexercised when removing bands from porcelain crowns to avoid fracturingthe porcelain (slit the band with a bur).

A “15M2tipDc” bracket is a welded variation of a “mesial rotation”bracket. The bracket is welded to a band with an added 4 degrees ofdistal crown tip when a straight wire is engaged. These features makethis variation especially important in the pre-prosthetic preparationfor upper 6-replacement with an implant or fixed bridge. When applyingopen coil from 7-5, it is common for the crown to move mesial, but theroot does not remain parallel. The forces applied away from the centeror rotation of the tooth creates unwanted tipping. Lack of rootparallelism or proper control of the palatal cusp can be a problem increating an ideal restorative replacement.

The mesial rotation is used to compensate for the forces applied to thedistal surface of the bracket, creating a rotation of the bicuspid. Acleat is standard on this variation as lingual mechanics are oftenrequired to further control the position of the palatal cusp. Bands mayalso be preferred when porcelain or gold crowns must be bracketed. Theband does not break the glaze of the porcelain, although care must beexercised when removing bands from porcelain crowns to avoid fracturingthe porcelain (slit the band with a bur).

A “15D” bracket is a distal rotation bonded bracket with mesial hook andan offset bonding pad. This variation should be also used whenever opencoil or chain will be applied to the mesial surface of the bicuspid, asis common in class II distalization cases. The added rotation willcompensate for the forces being applied away from the center of rotationof the bicuspid. This bracket could also be used for bicuspiddistalization into edentulous spaces, although the 15D2tipM is betterdesigned for this purpose.

A “15Ds” bracket is a distal rotation bonded bracket with a mesial hookand a small bonding pad. Used on teeth with short clinical crowns, wherethe standard offset pad is too large for the tooth. This variation isused on teeth with “distal rotations”, adding 4 degrees ofovercorrection to avoid finishing bends and early correction of therotation for an improved retention experience. This bracket could alsobe used when applying open coil force to the mesial of the bracket, asis common when opening the first bicuspid space. The distal rotationwill help compensate for the unwanted rotation of the bicuspid as theforce is applied away from the center of rotation. Another use of thisvariation is for class II distalization cases where a significant amountof retraction is needed to correct the class II. The retraction forcesapplied to the bracket would tend to create a rotation of the bicuspid,which can be compensated by the counter-rotation in the bracket.

A “15D2” bracket is a distal rotation bracket welded to a band with amesial hook and no lingual cleat. Used on teeth with distal rotations,short clinical crowns, and where heavy forces are to be applied to thetooth. By adding 4 degrees of over-correction, the rotation can be fullycorrected, eliminating the need for finishing bends. When applying heavy(stainless steel) open coil force to the mesial of the bracket, as iscommon when opening first bicuspid space, a band may be better to reducebracket debonding. For pre-implant preparation of upper 4s with opencoils, it may be better to use the variation with a weld variation(15D2tipM) to also control the root angulation. The distal rotation willhelp compensate for the unwanted rotation of the bicuspid as the forceis applied away from the center of rotation Also apply this variation tosevere class II cases where significant retraction of the bicuspid isplanned. The retraction forces, when applied to the bracket, tend tocreate a rotation of the bicuspid, which can be compensated by thecounter-rotation in the bracket. Bands may also be preferred whenporcelain or gold crowns must be bracketed.

A “15D2tipM” bracket is a distal rotation bracket welded to a band with4 degrees of mesial crown tip when a straight archwire is engaged. Thisvariation is especially helpful in the pre-prosthetic preparation forimplants (replacing upper 4), bridges, or for bicuspid distalizationcases to maintain root parallelism at the same time compensating for thedistal forces being applied to the buccal surface of the tooth. Thedistal rotation feature compensates for the forces being applied to themesial of the bracket. The standard mesial ball hook can be used forvertical elastic application. Bands are generally preferred whenporcelain or gold crowns must be bracketed.

A “15D2” bracket is a distal rotation bracket welded to a band with amesial hook and no lingual cleat. Used on teeth with distal rotations,short clinical crowns, and where heavy forces are to be applied to thetooth. By adding 4 degrees of over-correction, the rotation can be fullycorrected, eliminating the need for finishing bends. When applying heavy(stainless steel) open coil force to the mesial of the bracket, as iscommon when opening first bicuspid space, a band may be better to reducebracket debonding. For pre-implant preparation of upper 4s with opencoils, it may be better to use the variation with a weld variation(15D2tipM) to also control the root angulation. The distal rotation willhelp compensate for the unwanted rotation of the bicuspid as the forceis applied away from the center of rotation. Also apply this variationto severe class II cases where significant retraction of the bicuspid isplanned. The retraction forces, when applied to the bracket, tend tocreate a rotation of the bicuspid, which can be compensated by thecounter-rotation in the bracket. Bands may also be preferred whenporcelain or gold crowns must be bracketed.

A “15D2tipM” bracket is a distal rotation bracket welded to a band with4 degrees of mesial crown tip when a straight archwire is engaged. Thisvariation is especially helpful in the pre-prosthetic preparation forimplants (replacing upper 4), bridges, or for bicuspid distalizationcases to maintain root parallelism at the same time compensating for thedistal forces being applied to the buccal surface of the tooth. Thedistal rotation feature compensates for the forces being applied to themesial of the bracket. The standard mesial ball hook can be used forvertical elastic application. Bands are generally preferred whenporcelain or gold crowns must be bracketed.

A “14M” bracket is a mesial rotation bonded bracket with a mesial hookand an offset bonding pad. Used on teeth with “mesial rotations”,providing 4 degrees of overcorrection to eliminate finishing bends andto improve the retention experience. This bracket would also be usedwhen applying open coil force to the distal of the bracket, as is commonwhen opening the upper second bicuspid space. Using this variation wouldbe critical in pre-implant preparation with open coils. The mesialrotation will help compensate for the unwanted rotation of the bicuspidas the force is applied away from the center of rotation. This variationwould also be used in cases with excess spacing and minimum anchorage.Mesial forces applied to the bracket would tend to create a rotation ofthe bicuspid, which can be compensated by the counter-rotation in thebracket.

A “14Ms” is a mesial rotation bonded bracket with a mesial hook and asmall bonding pad. Used on teeth with short clinical crowns, where thestandard offset bonding pad is too large for the tooth. This variationis used on teeth with “mesial rotations”, providing 4 degrees ofovercorrection to eliminate finishing bends and to improve the retentionexperience. This bracket may also be used when applying open coil forceto the distal of the bracket, as is common when opening upper secondbicuspid spaces, but a band may be better in such cases to reducebracket debonding. Using this variation would be critical in pre-implantpreparation with open coils. The mesial rotation will help compensatefor the unwanted rotation of the bicuspid as the force is applied awayfrom the center of rotation. This variation would also be used in caseswith excess spacing and minimum anchorage. Mesial forces applied to thebracket would tend to create a rotation of the bicuspid, which can becompensated by the extra counter-rotation in the bracket.

A “14M2” is a mesial rotation bracket welded to a band with a mesialhook and no lingual cleat. Used on teeth with short clinical crowns, andwhere heavy forces are to be applied to the tooth. This variation isused on teeth with “mesial rotations”, providing 4 degrees ofovercorrection to eliminate finishing bends and to improve the retentionexperience. Full correction of rotations early in treatment, rather thanin the finishing stage, results in more stability in retention. Whenapplying open coil force to the distal of the bracket, as is common whenopening upper second bicuspid space, a band may be better to reducebracket debonding. For pre-implant preparation of upper 5s with opencoils, it may be better to use the variation with a weld variation(14M2tipD) to also control the root angulation. The mesial rotation willhelp compensate for the unwanted rotation of the bicuspid as the forceis applied away from the center of rotation. Also use this variation incases with excess spacing and minimum anchorage. Mesial forces appliedto the bracket will tend to create a rotation of the bicuspid, which canbe compensated by the counter-rotation in the bracket. Bands may also bepreferred when porcelain or gold crowns must be bracketed.

A “14M2tipDc” is a mesial rotation bracket welded to a band with anadded 4 degrees of distal crown tip when a straight wire is engaged.This variation is especially important in the pre-prosthetic preparationfor upper second bicuspid (5) replacement with an implant or fixedbridge. When applying open coil from 6-4, it is common for the crown tomove mesial, but the root tips. The forces applied away from the centeror rotation of the tooth cause this loss of root parallelism. Lack ofroot parallelism, and/or proper control of the palatal cusp can be aproblem in creating an ideal restorative replacement.

The mesial rotation is used to compensate for the forces applied to thedistal surface of the bracket, creating a rotation of the bicuspid. Acleat is standard on this variation as lingual mechanics are oftenrequired to further control the position of the palatal cusp. Bands mayalso be preferred when porcelain or gold crowns must be bracketed. Theband does not break the glaze of the porcelain, although care must beexercised when removing bands from porcelain crowns to avoid breakingthe porcelain (slit the band with a bur).

A “14D” bracket is a distal rotation bonded bracket with a mesial hookand an offset bonding pad. Used on teeth with “distal rotations”, adding4 degrees of overcorrection to avoid finishing bends and allowing earlycorrection of the rotation for an improved retention experience.Correcting rotations in the finishing stage is both time-consuming andunstable in retention. This variation should also be used whenever opencoil or chain is applied to the mesial surface of the bicuspid, as iscommon in class II distalization cases. The added rotation willcompensate for the forces being applied away from the center of rotationof the bicuspid. This bracket could also be used for bicuspiddistalization into edentulous spaces, although the 14D2tipM is betterdesigned for this purpose.

A “14Ds” bracket is a distal rotation bonded bracket with a mesial hookand a small bonding pad. Used on teeth with short clinical crowns, wherethe standard offset pad is too large for the tooth. This variation isused on teeth with “distal rotations”, adding 4 degrees ofovercorrection to avoid finishing bends and allow early correction ofthe rotation for an improved retention experience. Correcting rotationsin the finishing stage is both-time consuming and unstable in retention.

This bracket can also be used when applying open coil force to themesial of the bracket, as is common when opening the cuspid space. Thedistal rotation will help compensate for the unwanted rotation of thebicuspid as the force is applied away from the center of rotation.

This variation should also be used in class II distalization cases witha significant amount of retraction needed to correct the class II. Theretraction forces applied to the bracket would tend to create a rotationof the bicuspid, which can be compensated by the counter-rotation in thebracket.

A “14D2” bracket is a distal rotation bracket welded to a band with amesial hook and no lingual cleat. Used on teeth with short clinicalcrowns, and where heavy forces are to be applied to the tooth. Thisvariation is used on teeth with “distal rotations”, adding 4 degrees ofovercorrection to avoid finishing bends and early correction of therotation for an improved retention experience.

When applying heavy (stainless steel) open coil force to the mesial ofthe bracket, as is common when opening space for a blocked out cuspid, aband may be better to reduce bracket debonding. For pre-implantpreparation of upper 5s with open coils, it may be better to use thevariation with a an offset weld (14M2tipD) to also control the rootangulation. The distal rotation will help compensate for the unwantedrotation of the bicuspid as the force is applied away from the center ofrotation.

Use this variation in severe class II cases where significant retractionof the bicuspid is planned. Retraction forces, when applied to thebracket, tend to create a rotation of the bicuspid, which can becompensated by the distal counter-rotation in the bracket. Bands mayalso be preferred when porcelain or gold crowns must be bracketed.

A “14D2tipM” bracket is a distal rotation bracket welded onto a bandwith 4 degrees of mesial crown tip when a straight archwire is engaged.This “combination” variation is especially helpful in the pre-prostheticpreparation for implants (replacing upper 3), bridges, or for bicuspiddistalization cases to maintain root parallelism. The distal rotationfeature compensates for the forces being applied to the mesial of thebracket, typically creating a rotation of the bicuspid. The standardmesial ball hook can be used for vertical elastic application. Bands mayalso be preferred when porcelain or gold crowns must be bracketed.

A “13M” bracket is a mesial rotation bracket used on upper right cuspidswith “mesial rotations”, providing 4 degrees of overcorrection toeliminate finishing bends and to improve the retention experience. Thehook is on the distal, reducing distal-lingual rotation from elastic andcoil forces applied away from the center of rotation.

Mesial rotation brackets may also be used to compensate for the rotationtendency of open coil applied to the distal of the tooth, as when upperfirst bicuspid (4) space is opened. When open coil is applied to themesial of the bracket, opening space between the 2 and 3, a distalrotation bracket would be used to compensate. If the cuspid has a mesialrotation, and is scheduled for retraction, use the mesial rotationbracket. This will provide some over-correction of the rotation as thecanine is retracted.

A “13D” bracket is a distal rotation bracket applied to teeth with“distal rotations”, adding 4 degrees of overcorrection to avoidfinishing bends and early correction of the rotation for an improvedretention experience. Correcting rotations in the finishing stage isboth time-consuming and unstable in retention. In cases where stainlesssteel open coil is applied to the mesial of the bracket, such as openingspace to retrieve upper 2s blocked out in the palate, this variationshould be used to compensate for the rotation tendency.

A “12M” bracket is a mesial rotation bracket used on teeth with “mesialrotations”, providing 4 degrees of overcorrection to eliminate finishingbends and to improve the retention experience. Correcting rotations withfinishing bends in stainless steel archwires is tie-consuming andinefficient. Mesial rotation brackets may also be used to compensate forthe rotation tendency as open coil is applied to the distal of thetooth, as when upper cuspid (3) space is opened.

A “12D” bracket is a distal rotation bracket used on teeth with “distalrotations”, adding 4 degrees of overcorrection to avoid finishing bendsand to provide early correction of rotations for an improved retentionexperience. Be certain to view the study model with the archwire overlayto determine if the tooth is rotated, as some teeth appear straight whenthey are not.

A “12Mli” bracket is a combination bracket having added lingual roottorque (torque 14) for use on retroclined incisors and/or incisors thatare to be retracted a significant amount. In addition, this bracket hasa “mesial rotation” of 4 degrees for the early full correction of therotation, eliminating finishing bends, and improving the retentionexperience.

A “12Mli” bracket is a combination bracket having added lingual roottorque (torque 14) for use on retroclined incisors and/or incisors thatare to be retracted a significant amount. In addition, a “distalrotation” of 4 degrees has been added to avoid finishing bends and forfull correction of the rotation early in treatment, improving theretention experience.

A “12Mla” bracket is a combination bracket having added labial roottorque (−2) and mesial rotation of 4 degrees. Use this variation inclass III cases to limit upper incisor proclination AND when theincisors have a mesial rotation. This bracket is also used for thepalatal positioned lateral incisors to bring the root forward as thecrown is aligned, PLUS add over-correction to a mesial rotation.

A “12Dla” bracket is a combination bracket having added labial roottorque (−2) and distal rotation of 4 degrees. Use this variation inclass III cases to limit upper incisor proclination AND when theincisors have a distal rotation. This bracket is also used for thepalatal positioned lateral incisors to bring the root forward as thecrown is aligned, PLUS add over-correction to a distal rotation.

A “11M” bracket is a mesial rotation bonded bracket applied to teethwith a “mesial” rotation, providing 4 degrees of overcorrection toeliminate the need for finishing bends and to improve the retentionexperience. Rotating teeth with stainless steel finishing wires isinefficient, time-consuming, requires significant talent, and drainsenergy from the orthodontist.

A “11D” bracket is a distal rotation bonded bracket applied to teethwith a “distal” rotation, adding 4 degrees of overcorrection to avoidfinishing bends and early correction of the rotation for an improvedretention experience.

A “11Mli” bracket is a combination bracket having added lingual roottorque (torque 22) and mesial rotation. Apply to cases with retroclinedupper incisors and/or to cases where significant incisor retraction isplanned, AND the tooth has a “mesial” rotation. 4 degrees ofover-correction has been added to reduce finishing bends and to improvethe retention experience.

A “11Dli” bracket is a combination bracket with added lingual roottorque (torque 22) and distal rotation. Apply to cases with retroclinedupper incisors and/or to cases where significant incisor retraction isplanned, and the tooth has a distal rotation. Four (4) degrees ofovercorrection has been added to avoid finishing bends and to allowearly correction of the rotation for an improved retention experience.

A “11MLa” bracket has added labial root torque (+2) and mesial rotationof 4 degrees. Use this variation in class III cases to limit upperincisor proclination AND when the incisors have a mesial rotation. Itwould be unusual, but possible for an upper incisor to be blocked out tothe lingual. Retrieving such a tooth would leave the root still in thepalate, although the crown was aligned. The added labial root torquewould then be desirable to align the root with the adjacent teeth,improving retention. Cases where upper labial corticotomy is plannedwith rotated incisors, this bracket is perfect.

A “11DLa” bracket has added labial root torque (+2) and distal rotationof 4 degrees. Use this variation in class III cases to limit upperincisor proclination AND when the incisors have a distal rotation. Caseswhere upper labial corticotomy is planned with rotated incisors, thisbracket is perfect.

It should be noted that it is important that all brackets with addedlabial root torque be tightly tied with steel ligature ties whenrectangular archwires are engaged. As the root contacts the labialcortical plate, the crown will pull away from the archwire to thepalatal.

Appliances for the upper left quadrant are identical to those for theupper right, except that the numbers start with “2” instead of “1” forthe quadrant. The descriptions are the same, except when a specificbracket variation is referenced, the quadrant will change.

Lower Quadrant Brackets

A “36CIIE” bracket is a “bonded” convertible buccal tube with addedmesial rotation. Torque −25, angulation 0, rotation 12. At bonding, thebracket position should be altered for added distal crown tip (mesial ofthe bracket is more gingival), to give some distal crown tip. Thisvariation is designed for cases where significant class II elastics areplanned, to reduce the unwanted tooth movements of tipping, andmesial-lingual rotation. If 3 mm or more class II needs to be correctedby class II elastics, then this variation will have advantages over astandard Roth prescription.

A “36CIIE2” bracket is a convertible Buccal tube custom welded to a bandwith added (distal crown) tipback, added mesial rotation, no lingualcleat. Torque −25, angulation 3 (weld), rotation 12. Use this variationin cases where significant class II elastics are planned to reduce theunwanted tooth movements of tipping, and mesial lingual rotation, andmesial crown tipping. The crown tipback adds to the lower archanchorage, changing the line of force of the elastic, resulting in moretooth translation, and less extrusion.

A “36Up” is a molar uprighting bonded bracket This convertible buccaltube has added mesial rotation (−12), and added lingual root torque(torque −10) to correct lingual crown inclination. Tipped molarstypically have severe mesial-lingual rotation, lingual inclination, andof course mesial crown tipping. The bracket should be bonded to thetooth with added distal crown tip (mesial of the bracket more gingival)to allow full uprighting of the tipped molar.

This bracket may also be applied to a lower 7 or 8 for uprighting. Ifboth the 7 and 8 are to be retained, then the convertible tube in thisbracket makes heavy archwire engagement easier while allowing wirebending between the two teeth for the best alignment.

A “36Up2c” is a molar uprighting bracket welded to a band with a lingualcleat. This convertible buccal tube has added mesial rotation (−12), acustom weld for distal crown tipback (5 degrees), and added lingual roottorque (torque −10) to correct lingual crown inclination. Tipped molarsusually have severe mesial-lingual rotation, lingual inclination, and ofcourse mesial crown tipping. The lingual cleat may be used to attachposterior cross elastics for further lingual uprighting ability. Thisband may also be applied to a lower 7 or 8 for uprighting. If both the 7and 8 are to be retained, then the convertible tube in this bracketmakes heavy archwire engagement easier while allowing wire bendingbetween the two teeth for the best alignment.

A “35M” is a mesial rotation bonded bracket with a distal hook and anoffset bonding pad. Used on teeth with “mesial rotations”, providing 4degrees of overcorrection to eliminate finishing bends and to improvethe retention experience. Full correction of rotations early intreatment, rather than in the finishing stage, will result in morestability in retention. This bracket can also be used to counter theunwanted rotation when applying open coil force to the distal of thebracket, as is common in molar uprighting cases. Using this variationwould be critical in pre-implant preparation with open coils, as thecontrol of root positions and rotations is more critical in these cases.The mesial rotation feature will compensate for the unwanted rotation ofthe bicuspid as force is applied away from the center of rotation.

This variation may also be used in cases with excess spacing and minimumanchorage. Mesial forces applied to the bracket (such as power chain)tend to create a rotation of the bicuspid, which can be compensated bythe counter-rotation in the bracket. The offset bonding pad providesneeded extra retention, as the lower second bicuspids have the mostbonding failures.

With severe mesial rotations of lower second bicuspids, there is risk ofcreating a posterior crossbite as the alignment wire places a buccalforce on the molars when the mesial rotation is activated. The temporaryuse of a LLA to maintain the molar width during the alignment of severeM rotations on second bicuspids is recommended.

A “35M2” bracket is a mesial rotation bracket welded to a band with adistal hook and no lingual cleat. This variation is used on teeth with“mesial rotations”, providing 4 degrees of overcorrection for thepurpose of eliminating finishing bends and to improve the retentionexperience. Full correction of rotations early in treatment, rather thanin the finishing stage, will result in more stability in retention.

This bracket can also be used to counter the unwanted rotation whenapplying open coil force to the distal of the bracket, as is common inmolar uprighting cases. Using this variation would be critical inpre-implant preparation with open coils, as the control of rootpositions and rotations is more critical in these cases. Mesial rotationwill help compensate for the unwanted rotation of the bicuspid as forceis applied away from the center of rotation.

This variation may also be used in cases with excess spacing and minimumanchorage. Mesial forces applied to the bracket (such as power chain)tend to create a rotation of the bicuspid, which can be compensated bythe counter-rotation in the bracket. The offset bonding pad providesneeded extra retention, as the lower second bicuspids have the mostbonding failures.

A “35D” bracket is a distal rotation bonded bracket with a distal hookand an offset bonding pad. Used on teeth with “distal rotations”,providing 4 degrees of overcorrection to reduce finishing bends and toimprove the retention experience. Full correction of rotations early intreatment, rather than in the finishing stage, will result in morestability in retention.

This bracket can also be used to counter the unwanted rotation whenapplying open coil force to the mesial of the bracket, as is common whenreopening a lower first bicuspid (4) space. Using this variation wouldbe critical in pre-implant preparation (4s) with open coils, as thecontrol of root positions and rotations is more critical in these cases.The distal rotation compensates for the unwanted rotation of thebicuspid as the force is applied away from the center of rotation.

This variation may also be used when distalizing a bicuspid intoedentulous spaces. Open coils are used to distalize the bicuspid,applying forces mesial of the bracket. Forces applied to the mesial ofthe bracket are also common in maximum anchorage cases to correctprotrusion, possibly closing first molar extraction space. The offsetbonding pad provides extra retention, and height consistency whenbonding first and second bicuspids together. The second bicuspids havemore reason to have the offset bonding pad, as the lower secondbicuspids have the most bond failures.

A “35D2” bracket is a distal rotation bracket welded to a band with adistal hook and offset pad. Used on teeth with “distal rotations”,providing 4 degrees of overcorrection to reduce finishing bends and toimprove the retention experience. Correction and over-correction ofrotations early in treatment, rather than in the finishing stage, willresult in more stability in retention. This bracket can also be used tocounter the unwanted rotation when applying open coil force to themesial of the bracket, as is common when reopening a lower 4 space.Using this variation would be critical in pre-implant preparation (4s)with open coils, as the control of root positions and rotations is morecritical in these cases. The distal rotation will help compensate forthe unwanted rotation of the bicuspid as the force is applied away fromthe center of rotation. This variation would also be used in bicuspiddistalization cases where open coils are used to distalize the bicuspid.Forces applied to he mesial of the bracket are also common in maximumanchorage cases to correct protrusion, possibly closing first molarextraction space.

The hook is applied to the distal for the use of short class IIelastics. Since the majority of cases treated are class I or II, thehook placement on the distal has added advantages to the typicalpractice. Do not change sides with this rotation bracket to get the hookon the mesial or the rotation will create the wrong rotation. If youmust have a hook on the mesial, then use a mesial rotation bracket(welded to a band) on the opposite side, but this is dangerous applianceplanning. One mistake with a variation that looks different whenbonding, and the problems magnify instead of being corrected.

Bands on bicuspids are used with teeth that have been damaged (largefillings or crowns), severely rotated teeth (mesial rotations), and oncases with skeletal and dental closed bites. The clinical crown ofbicuspids in closed bite cases is usually shorter due to the strongmuscles of mastication, making bands more suitable for a secureattachment to the tooth.

A “34M” bracket is a mesial rotation bonded bracket with a distal hookand an offset bonding pad. Used on teeth with “mesial rotations”,providing 4 degrees of overcorrection to reduce finishing bends and toimprove the retention experience.

This bracket can also be used to counter the unwanted rotation whenapplying open coil force to the distal of the bracket, as is common whenopening spaces for lower 5s or molar uprighting. This variation would becritical in pre-implant preparation (5s) with open coils, as the controlof root positions and rotations is more critical in these cases. Themesial rotation compensates for the unwanted rotation of the bicuspid asthe force is applied away from the center of rotation.

This variation may also be used in cases with excess spacing and minimumanchorage. Mesial forces applied to the bracket (such as power chain)tend to cause rotation of the bicuspid, which is compensated by thecounter-rotation in the bracket. The offset bonding pad provides forextra retention.

A “34M2” bracket is a mesial rotation bracket welded to a band with adistal hook, no lingual cleat.

This bracket can also be used to counter the unwanted rotation whenapplying open coil force to the distal of the bracket, as is common whenopening space for lower 5s or molar uprighting. This variation iscritical in pre-implant preparation with open coils, as the control ofroot positions and rotations is more critical in these cases. The mesialrotation will help compensate for the unwanted rotation of the bicuspidas the force is applied away from the center of rotation.

This variation may also be used in cases with excess spacing and minimumanchorage. Mesial forces applied to the bracket (such as power chain)tend to create a rotation of the bicuspid, which can be compensated bythe extra counter-rotation in the bracket.

The hook is applied to the dial for the use of short class II elastics.Bands on bicuspids are used with teeth that have been damaged (largefillings or crowns), severely rotated teeth (mesial rotation), and oncases with skeletal and dental closed bites. The clinical crown ofbicuspids in closed bite cases is usually shorter due to the strongmuscles of mastication, making bands more suitable for a secureattachment to the tooth. Since the majority of cases treated are class Ior class II cases, the hook placement on the distal has added advantagesto the typical practice. In class III cases, this variation can bewelded (special request) on the opposite side so the hook is now on themesial, but a “distal” rotation bracket must be used to create themesial rotation on the opposite side. Any errors in applying thisunusual variation would create the wrong correction.

A “33M” mesial rotation bracket with a distal hook. Torque −11,angulation 7, mesial rotation 4.

This bracket can also be used to counter the unwanted rotation whenapplying open coil force to the distal of the bracket, as is common whenreopening a first bicuspid space. Using this variation would be criticalin pre-implant preparation (4) with open coils, as the control of rootpositions and rotations is more critical in these cases. The mesialrotation will help compensate for the unwanted rotation of the bicuspidas the force is applied away from the center of rotation.

This variation may also be used in cases with excess spacing and minimumanchorage. Mesial forces applied to the bracket (such as power chain)tend to create a rotation of the cuspid, which can be compensated by theextra counter-rotation in the bracket.

When a tooth has a significant mesial rotation, and is to be retracted,choose the mesial rotation rather than the distal rotation needed tooffset the distal lingual rotation tendency during retraction.

The following are mesial rotation brackets having the featurespreviously described for MS1 mesial rotation brackets: “31M”, “32M”,“33M”.

The following are distal rotation brackets having the featurespreviously described for MS1 distal rotation brackets: “31D”, “32D”,“33D”.

Appliances for the lower right quadrant are identical to those for thelower left, except that the numbers start with “4” instead of “3” forthe quadrant. The descriptions are the same, except when a specificbracket variation is referenced, the quadrant will change.

Combination brackets (i.e. brackets adapted to correct rotations aboutmultiple axis) for 33, 32, 31 ( and 43,42,41) also are used with labialroot torque+the appropriate rotation for teeth that need additionallabial root torque (class III cases) and full/over-correction of arotation.

Thus, specific embodiments and applications of orthodontic treatmentmethods and brackets have been disclosed. It should be apparent,however, to those skilled in the art that many more modificationsbesides those already described are possible without departing from theinventive concepts herein. The inventive subject matter, therefore, isnot to be restricted except in the spirit of the appended claims.Moreover, in interpreting both the specification and the claims, allterms should be interpreted in the broadest possible manner consistentwith the context. In particular, the terms “comprises” and “comprising”should be interpreted as referring to elements, components, or steps ina non-exclusive manner, indicating that the referenced elements,components, or steps may be present, or utilized, or combined with otherelements, components, or steps that are not expressly referenced.

IP Software

It is contemplated that preferred software tools will comprise one ormore of the following input/output mechanisms: (a) a window based formadapted to facilitate the input, output, and maintenance of patientcharacteristics (FIG. 31); (b) a window based treatment option selectionform that facilitate the selection and modification of a treatment plansfrom a set of existing treatment plans (FIG. 32); (c) an appliancedesign window adapted to display and allow modifications to a set ofappliances to be used (FIG. 33); (d) a treatment history window adaptedto facilitate the input, output, and maintenance of treatment relateddata (FIG. 34); (e) a presentation window adapted to facilitate theorganization and display of pictures of a patient and the patient'steeth (FIG. 35). In preferred embodiments, pictures shown in the windowof FIG. 34 will be enlargeable as shown in FIG. 36 to permit betterviewing of the picture.

The patient characteristic form of FIG. 31 is used to input thecharacteristics of a particular patient. Such characteristics mayinclude but are not necessarily limited to: existence and type ofcrossbite; missing teeth; periodontal condition; dentition; type ofbite; arch characteristics; bracket offsets for individual teeth.

The appliance design window of FIG. 33 allows a dentist to design anappliance that specifically addresses the needs of a particular patient.It will preferably include a graphic illustrating the current form ofthe appliance being designed. It is contemplated that one or morestandard designs may be used as a starting point for the design process.Such standard designs may, either manually via dentist manipulation orautomatically via software rules be modified such that a design that isappropriate for a chosen treatment plan and the characteristics of thepatient.

EXAMPLE #1

a. Determining the arch shape and size: The study model is scanned andthe inside shape of the mandible is determined (ovoid, tapered, orsquare) using sample shapes. This is done ONLY on the lower study model.Once one of these 3 shapes is chosen, then the size (small, medium,large, non-extraction) is chosen from the available archform shapes byoverlaying the shape over the study model teeth, leaving approx. 2 mm ofspace for the brackets on the face of the teeth.

Next, the treatment planned for that case is factored into the archform.If extraction is the treatment, then the original archform ismaintained. If non-extraction is chosen then an enlarged archform ischosen. It is possible to choose one size for the lower and another forthe upper in cases with transverse problems (ie. Posterior crossbite).

Next, the esthetic desires of the patient are considered. Those desiringa wide smile may have a larger archform selected (or even a differentshape), even in a case that extraction is being done.

Once the lower archform is determined, the upper one is automaticallychosen to be “coordinated” unless the doctor edits this for treatmentreasons.

b. Determining the width of 2-2 upper/lower for looped wires

Exactly the same as the current mixed dentition analysis program indiagnosticum, the mesial-distal width of the upper and lower incisors ismeasured. The sum of the incisor width is then used to choose the sizeof the looped archwires. Since the bracket is set in the middle of thetooth, it seems reasonable to me to select the looped size (size is thedistance between loops) to be the measured size plus 1 mm on the upperand 2 mm on the lower.

c. Ordering standard setup, deleting wires not wanted, adding wires noton the standard setup

There must be standard sets of wires to be used as a starting point inthe archwire selection, especially important for new students that haveno idea what to select. If a standard set of wires is chosen and laterthey need another wire, they can get this from the repair kit. If theydo not use one of the wires in the standard single patient setup, theycan put the extra wire back into the repair kit.

Standard sets will be listed for:

i. Non-extraction, class I or II case: 014N, 016N, 016ss, 020ss, 19x25ssKH upper, 19x25ss (no loop) lower, 018ss in that order, both upper andlower (total 12 wires)

ii. Non-extraction, class III case: upper: 012N, 014N, 016N,016ss,020ss,19x15ss (no loop), 21x25ss,018ss. Lower: 016N, 016ss, 020sskeyhole, 018ss

iii. Bicuspid extraction, sliding mechanics: 014N, 016N, 016ss, 020ss,19x25ss Keyhole, 018ss. All wires upper+lower

iv. Bicuspid extraction, class II with 2 step retraction upper: upper:014N, 016N, 016ss, combo (or 020ss if not available), 19x25ss T loop,018ss. Lower: 014N, 016N, 016ss, 020ss, 19x25 keyhole, 018ss

v. Upper 7 molar extraction: upper: 014N, 016N, combo (or 020ss if notavailable), 19x25ss T loop, 018ss. Lower: 014N, 016N, 020ss, 19x25ss,018ss

Each of these wires should be listed for the standard setup with amethod to remove that wire and to add from a list of wires for a“custom” setup. The extra wire sizes are listed from the total list ofwires available in that shape PLUS the wires not available in thatshape, but may be used.

d. reorder repair kit. As wires are used from the wire repair kit, theyneed to be replaced. This should go with the next NEW patient order, butit is conceivable that we would have to ship out 1 wire someday due tomismanagement of the repair kit inventory by a student. I can see a newdentist not ordering wires for a new patient, but using the wires fromthe repair kit, reducing inventory to 1 wire of each size!!

Replacement repair kit wires need to be selected from a list, indicatingthe size and shape (9 possible) and the number needed. This could getcomplicated. For example: 1—19x25KH loop Ovoid-medium, 2—018ssSquare-small, etc are needed in the same order. Hard to list all 500wires!!

e. Internet order sent/received: Electronic ordering needs to be done assoon as the wires are selected in California PDS (and Spain). Thepatient name, maybe case number, date the wires needed, doctors name,shipping address (some have 2 practice locations and we do not want tosend the wires to the wrong place!), billing info, etc. are needed. Mustbe easy to use for the doc.

Receipt of the order at PDS is followed by e-mail confirmation with theexpected shipping date, arrival to their practice. This is followed byfilling the order, generating an invoice (including patient name, doctorname, etc. plus Sales and VAT tax), and shipping (customs tag may beneeded) ASAP. Monthly billing by patient name. The sale is recorded andaccounts receivable tracked.

f. Shipping label. Electronically generated from the order received withthe proper shipping location for that patient.

Thus, specific embodiments of appliances, systems, methods, and toolsfor orthodontic treatment of patients have been disclosed. It should beapparent, however, to those skilled in the art that many moremodifications besides those already described are possible withoutdeparting from the inventive concepts herein. The inventive subjectmatter, therefore, is not to be restricted except in the spirit of theappended claims. Moreover, in interpreting both the specification andthe claims, all terms should be interpreted in the broadest possiblemanner consistent with the context. In particular, the terms “comprises”and “comprising” should be interpreted as referring to elements,components, or steps in a non-exclusive manner, indicating that thereferenced elements, components, or steps may be present, or utilized,or combined with other elements, components, or steps that are notexpressly referenced.

1. A method of treatment comprising using an IP System to reposition orreorient at least one tooth of a patient.
 2. The method of claim 1comprising using IP Diagnosis Software to specify an IP Appliance Setfor the patient, using IP Ordering Software to order the specified IPAppliance Set, and using the specified and ordered IP Appliance Set toreposition or reorient at least one tooth of the patient.
 3. The methodof claim 2 further comprising using an IP Band Fitting Kit inconjunction with the IP Diagnosis Software to specify the IP ApplianceSet.
 4. The method of claim 2 further comprising using an IP Bracket Setto replace a bracket of the IP Appliance Set.
 5. The method of claim 2further comprising using a GMPOI Holder to position a bracket of the IPAppliance Set an a tooth of the patient.
 6. An apparatus comprising: ahandle; a pair of opposed gripping members, each member comprising agripping surface, each gripping surface comprising a forward edge; aGMPOI positioned between the handle and the forward edges.
 7. Theapparatus of claim 6 wherein the GMPOI extends above or below thegripping surfaces.
 8. The apparatus of claim 6 wherein the GMPOI extendsabove or below the handle.
 9. The apparatus of claim 6 wherein the GMPOIis positioned within 0.5 inches from the forward edges.
 10. Theapparatus of claim 6 wherein the gripping edges are coplanor, and theGMPOI is an elongated planar member the plane of which is perpendicularto the plane of the gripping edges
 11. The apparatus of claim 6 whereinthe apparatus comprises a height gauge.
 12. The apparatus of claim 11wherein the height gauge comprises first and second parallel planarmembers separated by a fixed distance and extending outward from theapparatus with the first parallel planar member being substantiallylonger than the second parallel planar member, the shorter planar membercomprising a wire loop.
 13. The apparatus of claim 12 wherein thegripping edges are coplanor, and the GMPOI is an elongated planar memberthe plane of which is perpendicular to the plane of the gripping edges,and is parallel to or coplanar with the planar members of the heightgauge.
 14. The apparatus of claim 6 wherein the apparatus is one of aset of apparatus, each apparatus of the set comprising a height gaugethat corresponds to a prescribed bracket height for a particular toothof a particular patient.
 15. The apparatus of claim 6 wherein theapparatus is one of a plurality of apparatus wherein each apparatuscomprises a bracket gripped by the pair of opposed gripping members. 16.A method of coupling an orthodontic bracket to a tooth comprising:providing a bracket holder; utilizing the bracket holder to place abracket on a tooth; inserting a portion of the bracket holder into thebracket; and rotating the bracket holder so as to rotate the bracket.17. The method of claim 16 wherein the portion of the bracket holderinserted into the bracket is part of a height gauge.
 18. The method ofclaim 16 wherein the portion of the bracket holder inserted into thebracket is part of a GMPOI.
 19. A method of coupling an orthodonticbracket to a tooth comprising: providing a bracket holder comprising agripping member position and orientation indicator (GMPOI); utilizingthe bracket holder to grip a bracket and to place the bracket on atooth; and while viewing the position and orientation of the GMPOIrelative to the tooth on which the bracket is being mounted, rotatingand/or moving the bracket holder so as to set the orientation andposition of the bracket.
 20. The method of claim 19 further comprising:subsequently causing the bracket holder to release the bracket;inserting a portion of the bracket holder into the bracket; and rotatingthe bracket holder so as to rotate the bracket.
 21. The method of claim20 wherein the portion of the bracket holder inserted into the bracketis part of a height gauge.
 22. The method of claim 21 wherein theportion of the bracket holder inserted into the bracket is part of theGMPOI.
 23. A method of coupling a plurality of orthodontic brackets to aplurality of teeth comprising: providing a plurality of bracket holders,each holder having a grasping member adapted to receive and hold abracket; providing a plurality of brackets; and prior to coupling anyone of the brackets to a tooth, causing each bracket holder to receiveand hold a bracket.
 24. The method of claim 23 further comprising, priorto coupling any one of the brackets to a tooth, arranging the bracketholders in an order at least partially dependent on the order in whichthe brackets are to be installed, or at least partially dependent on therelative positions of the teeth to which the brackets are to be coupled.25. A method of selecting an archwire for a patient comprising:obtaining a representation of the patient's inner arch curve (PIAC);selecting an archwire shape based at least partially on the PIACrepresentation; and selecting an archwire to be used based on theselected archwire shape.
 26. The method of claim 25 wherein selecting anarchwire shape comprises providing a translucent or transparent sheetbearing a representation of an archwire, and attempting to superimposethe archwire representation on the PIAC representation.
 27. The methodof claim 25 wherein obtaining the PIAC representation comprisesobtaining an image of the patient's teeth and arch, and selecting anarchwire shape comprises viewing at least a portion of the image throughthe translucent or transparent sheet.
 28. The method of claim 25 whereinobtaining the PIAC representation comprises obtaining a study model ofthe patient's teeth and arch, and selecting an archwire shape comprisesviewing at least a portion of the study model through the translucent ortransparent sheet.
 29. The method of claim 25 further comprisingselecting an initial archwire size based at least partially on the PIACrepresentation, and wherein selecting an archwire comprises selecting anarchwire to be used based on the selected archwire shape and selectedinitial archwire size.
 30. The method of claim 29 further comprisingselecting a final archwire size after considering something other thanthe PIAC representation, and wherein selecting an archwire comprisesselecting an archwire to be used based on the selected archwire shapeand selected final archwire size.
 31. An archwire selection aidcomprising a translucent or transparent sheet bearing one or morerepresentations of archwires.
 32. An automated system for selecting anarchwire for a patient comprising: a patient internal arch curverecorder adapted to obtain a representation of the patient's internalarch curve; data on available archwires; a mechanism adapted to comparean obtained representation of a patient's internal arch curve with thedata on available archwires and to identify an archwire based on anysuch comparison.
 33. The system of claim 32 wherein the system furthercomprises data relating to the current position, orientation, shapeand/or size of the patient's teeth.
 34. The system of claim 32 whereinthe system further comprises an input mechanism adapted to accept atreatment diagnosis.
 35. The system of claim 34 wherein the mechanismadapted to compare an obtained representation of a patient's internalarch curve with data on available archwires is also adapted to utilizeany input treatment diagnosis in identifying an archwire.
 36. The systemof claim 32 wherein the system comprises a communications mechanismadapted to communicate to an archwire supplier that the identifiedarchwire is to be provided to a user of the system.
 37. The system ofclaim 32 wherein the patient internal arch curve recorder comprises ameans for obtaining an electronic representation of at least a portionof a study model or image.
 38. The method system of claim 37 wherein thepatient internal arch curve recorder comprises a digital camera orscanner.
 39. The method system of claim 32 wherein the data on availablearchwires comprises data on archwires comprising one of at least threedifferent shapes.
 40. The system of claim 39 wherein the data onavailable archwires comprises data on at least two archwires having thesame shape wherein one of the archwires is adapted for use in anon-extraction treatment plan and another of the archwires is adaptedfor use in an extraction treatment plan.
 41. An automated system forselecting and ordering an archwire for a patient comprising: means forselecting an archwire from a plurality of available archwires; and meansfor ordering the selected archwire from an archwire supplier; whereinthe selection of an archwire is based, at least in part, on all of thefollowing factors: the patient's jawbone structure; a dentists preferredtreatment option; and the sizes and shapes of available archwires.
 42. Amethod of orthodontic treatment comprising: specifying an initialorthodontic treatment plan to be applied to a patient where the patienthas teeth, each of the patient's teeth has a position and anorientation, and the treatment is designed to modify either or both theposition and orientation of at least one of the patient's teeth;identifying each tooth that will have an undesired orientation uponcompletion of the initial treatment plan; modifying the initialtreatment plan to change the orientations that the identified teeth willhave upon completion of the treatment plan.
 43. The method of claim 42wherein identifying each tooth that will have an undesired orientationupon completion of the initial treatment is accomplished through the useof automated methods.
 44. The method of claim 43 wherein the automatedmethods utilize the initial treatment plan in addition to the currentpositions and orientations of the patient's teeth to identify each tooththat will have an undesired orientation upon completion of the initialtreatment.
 45. The method of claim 44 wherein at least some of theidentified teeth do not currently have undesired orientations.
 46. Themethod of claim 42 wherein identifying each tooth that will have anundesired orientation upon completion of the initial treatment planinvolves identifying teeth that currently have undesired orientations.47. The method of claim 46 wherein identifying teeth that currently haveundesired orientations comprises identifying each tooth that has amesial or distal rotation.
 48. The method of claim 47 whereinidentifying each tooth that has a mesial or distal rotation comprisesfirst identifying a shaped archwire to be used in treatment, and thendetermining whether the mesial or distal surface of a particular toothwould be farthest from the archwire if the archwire were positionedadjacent to the patient's teeth.
 49. The method of claim 42 whereinmodifying the initial treatment plan to change the orientations that theidentified teeth will have upon completion of the treatment plancomprises changing the orientations of the identified teeth duringinitial treatment and maintaining the orientations of the identifiedteeth during subsequent treatment.
 50. The method of claim 49 whereinthe length of the period during which the orientations of the identifiedteeth are maintained is at least X% of the length of the period duringwhich the orientations were changed where X is one of 75, 50, 25, and10.
 51. The method of claim 42 wherein modifying the initial treatmentplane comprises identifying one or more MS1 brackets for use intreatment.
 52. An orthodontic bracket adapted to apply torque to a toothwhen coupled to a shaped archwire, the bracket comprising a visualindicator that indicates the type of torque it is adapted to provide.53. The bracket of claim 52 wherein the indicator indicates a set ofteeth the bracket is adapted to be used on, and the set comprises teethin one of the upper right, upper left, lower right, and lower leftquadrants of a patients mouth.
 54. The bracket of 52 wherein theindicator comprises one or more colored dots painted on the bracket. 55.The bracket of 54 wherein the bracket comprises tie wings and the dotsare painted on the tie wings.
 56. The bracket of 52 wherein theindicator indicates that the bracket comprises one or more of thefollowing: mesial rotation, distal rotation, lingual rotation, labialrotation, mesial angulation, and distal angulation.
 57. The bracket of52 wherein the bracket is an MS1 bracket.
 58. A bracket comprisingmesial or distal rotation, and at least one of the following: lingualrotation, labial rotation, mesial angulation, and distal angulation. 59.A set of brackets comprising at least X MS1 brackets where X is 1, 5,10, and
 30. 60. A method of orthodontic treatment comprising utilizingan orthodontic bracket on a tooth wherein the bracket is adapted toovercorrect the orientation of the tooth.
 61. The method of 60 whereinthe bracket is adapted to provide 4 degrees of overcorrection.
 62. Abracket assembly comprising a bracket having an archwire receiving slotand slot modifying member inserted into the slot.
 63. The assembly ofclaim 62 wherein the bracket is a ceramic bracket having a contouredbase adapted to couple the bracket to a tooth.
 64. The assembly of claim63 wherein the base comprises one or more indentations adapted todecrease the amount of surface area in contact with a tooth when thebase is coupled to a tooth.
 65. (canceled)
 66. (canceled)